The mechanism for this injury (rotating the upper body with all weight on one leg) is very unusual because it is usually the result of substantial force, such as being struck by a car or a fall from a height. In the knee, the occult fracture is most often a nondisplaced lateral tibial plateau fracture. Even if no fracture is actually seen, a fat-fluid level means an occult fracture is present-a finding similar to the fat-pad sign after an elbow injury. The x-ray film demonstrates a fat-fluid level. You let your judgment trump the imaging criteria and order a knee x-ray film results are shown at right ( Figure 1). Otherwise, the rest of his physical examination is normal. You ask him to walk, which he can do, but with fairly significant discomfort.īased on criteria from the Ottawa Knee Rule, the patient doesn’t need x-ray films, but you feel something is wrong here, especially with the acute effusion. There is no joint line tenderness and the ligaments are all fortunately stable. You compare it with the other knee and note that there is definitely a difference. His knee flexion is mildly limited, but extension is full. With his knee as flexed as is tolerable, you palpate just lateral to the patellar tendon and note the bulge of a small effusion. He is guarding his injured knee but has symmetric pulses in his feet. On examination, he is afebrile with otherwise normal vital signs. Just to be sure you eliminate identifiable risk factors for early osteoporosis, such as steroid or immunosuppressant use, seizure medications, reflex sympathetic dystrophy, or an eating disorder. He is otherwise healthy with no medical problems and takes no medication. He said it “gave out” while he was dancing, doing “the Twist.” He denies any other injury or pain or any prior orthopedic problems. He felt fine just before the injury but now states he can barely walk. It most often cannot address fractures associated with dislocation or knee instability.A 31-year-old man presents to the emergency department with diffuse knee pain after a low-energy injury. While helpful in classifying many tibial plateaus, it does not describe about 10% of all cases. Schatzker Type VI: Transverse fracture with a dissociation between the midsection of the bone and the narrow portion with many open and associated with soft tissue damage.Schatzker Type V: Wedge fracture of lateral and medial tibial plateau often with lateral depression, usually resulting from high energy trauma.Schatzker Type IV: Medial fracture of the tibial plateau with a split or depression often associated with damage to soft tissue, which can occur in both osteoporosis and traumatic injury cases.Depression in the lateral tibial plateau without a wedge or other fracture, most often in people with osteoporosis. Schatzker Type II: Split, wedge-shaped fracture combined with a deeper depression in the bone, often in people with osteoporosis or low bone quality.Schatzker Type I: A wedge-shaped fracture with minimal depression that often occurs in younger people.It is a system that describes the location and severity of a tibial plateau fracture. Doctors often use the Schatzker classifications system in North America.
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