Compartment syndrome is defined as a critical pressure increase within a confined
compartmental space.
This condition causes a decline in the perfusion pressure to the compartment tissue,
which without timely diagnosis and treatment will lead to ischaemia, necrosis, and
permanent disability of the affected region. If left untreated, compartment syndrome
can lead to limb loss, multi-organ failure, and death.
In this article, we shall look at the pathophysiology, clinical features and management
of acute compartment syndrome.
Pathophysiology
Compartment syndrome typically occurs following traumatic injury or fractures that
cause vascular injury. However other causes include iatrogenic vascular injury (postoperatively), tight casts or splints, deep vein thrombosis, and post-reperfusion
syndrome swelling.
Where there is a closed (fascial) compartment, any fluid that is deposited therein will
cause an increase in the intra-compartmental pressure. As this pressure increases,
the lower pressure venous system will first be compromised, so leading to venous
congestion and a further increase in the intra-compartmental pressure.
The capillaries will subsequently be compressed and arterial supply to the muscles
will cease, leading to ischaemia and subsequent infarction. In the final stages, the
arteries will be compressed, however the condition should be recognised well before
this point.
The most common sites affected are in the lower limb (anterior tibial, peroneal
compartment, and the superficial & deep posterior compartments), however it can also
occur in the forearm (ventral and dorsal compartments) and rarely in the gluteal region
and abdominal cavity.
By TeachMeSeries Ltd (2019)
Figure 1 – Cross section of the muscles of the distal forearm, highlighting those of the posterior compartment
Clinical Features
The
characteristic
feature
of
compartment
syndrome
is pain
that
is disproportionate to the injury, or is worsening despite treatment (ischaemia). This
pain can be worsened through passive movement, typically assessed by moving a
digit on the hand or foot, in doing so produces intense pain in the compartment
Other features may include paraesthesia in the cutaneous distribution of the affected
nerve (secondary to nerve compression) and a generalised muscular
tenderness and swelling.
If the disease progresses, the features are acute arterial insufficiency will subsequently
develop (often referred to as the ‘5 P’s’): Pain (disproportionate to the injury), Pallor
(or mottled, which becomes non-blanching), Perishingly cold, Paralysis,
and Pulselessness.
Investigations
The diagnosis of compartment syndrome is essentially clinical, based on the
symptoms and risk factors present. Clinicians should have a high degree of clinical
suspicion for compartment syndrome in post-operative patients.
Compartmental pressure can be measured by various methods if needed; in situations
where the diagnosis is in doubt, an MRI scan of the affected compartment is often the
most clinically useful.
Management
The most important part of the management is early recognition and discussion with
the orthopaedic/general/plastic surgeon. Initial management prior to definitive
intervention include:
 Keep the limb at a neutral level with the patient (do not elevate or lower)
 Improve oxygen delivery with high flow oxygen and augment blood pressure
with IV crystalloid fluids
 Remove any constricting dressings or split any circumferential casts
 Treat symptomatically with opioid analgesia (with anti-emetics)
The definitive treatment is with an emergency open fasciotomy (Fig. 2) to relieve the
pressure inside the compartment. The skin incisions are left open, and a re-look is
planned for 24-48 hours. Monitor electrolyte and renal function closely, due to the
potential effects of rhabdomyolysis or reperfusion injury.
Adapted from ‫[ نیمرآ‬CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
Figure 2 – Fasciotomy for Compartment Syndrome in Forearm
Key Points

Compartment syndrome is most common in the lower limbs, typically following
traumatic injury or fractures

Diagnosis is clinical, the main symptom being pain disproportionate to the injury or
worsening despite treatment

Definitive treatment is with an emergency open fasciotomy

Monitor the patient for rhabdomyolysis and reperfusion syndrome as potential
complications
A fractured neck of femur (NOF) is a common orthopaedic presentation. Over
65,000 hip fractures each year are recorded in the UK alone, and they are becoming
increasingly frequent due to an aging population; with associated lengthy hospital
stays and an estimated cost of over £7500 per fracture.
The mortality of a femoral neck fracture is up to 30% at one year, in part due to the
fracture, and also due to the frailty of the patient population. Consequently, these
fractures require specialist care to reduce mortality and morbidity.
In this article, we will look at the classification, anatomy, clinical and radiological
features, and management of neck of femur fractures.
Aetiology
By TeachMeSeries Ltd (2019)
Figure 1 – The bony landmarks of the anterior proximal femur
Neck of femur fractures are typically caused either by:


Low energy injuries – such as a fall in frail older patient; or
High energy injuries – such as a road traffic collision, affecting the ipsilateral side.
The neck of the femur is around 130 degrees to the shaft (also anteverted by roughly
10 degrees), with the femoral head sitting within the acetabulum.
The femoral head’s blood supply is primarily uni-directional, most arriving from the
medial femoral circumflex artery* (arising from the deep femoral artery). The medial
femoral circumflex artery lies directly on the femoral neck and is thus vulnerable to
damage in a fracture.
*There is supply in the early days of life from the ligamentum arteriosum within the
ligamentum teres, however dramatically reduces in size in later life, and also minor
contributions from collateral arteries.
Classification
Neck of femur fractures can be classified by the fracture line in relation to the joint
capsule:


Intracapsular – either subcapital (through the junction of the head and neck) or
basocervical fracture (through the base of femoral neck)
Extracapsular – either intertrochanteric (between the two trochanters) or subtrochanteric
(<5cm distal to the lesser trochanter)
The Garden Classification can be used to further classify intracapsular fractures:
Garden
Classification
Simplified Classification
I
Non-displaced
Incomplete
Complete fracture but nondisplaced
II
III
Description
Displaced
Complete fracture, partial displacement
Complete fracture fully displaced
IV
Table 1 – The Garden Classification for Intracapsular Hip Fracture
Clinical Features
A patient will typically present with a history of a recent fall or trauma,
with significant pain(in the groin, over the hip, in the thigh, or the knee) and
an inability to weight bear.
There may be an associated history of chronic metabolic problems such as
osteoporosis or renal failure
On examination, the leg is characteristically shortened and externally rotated (due
to the pull of the short external rotators, Fig. 2), with pain on pin-rolling the leg and
axial loading. The patient will be unable to straight leg raise.
Fortunately, distal neurovascular deficits are rare in isolated neck of femur fractures.
However, a full neurovascular examination of the limb is essential, with any deficits
urgently acted on accordingly.
By TeachMeSeries Ltd (2019)
Figure 2 – Externally rotated and shortened right lower limb
Differential Diagnoses
Fractures of the pelvis (especially pubic ramus fractures), acetabulum, femoral head
and femoral diaphysis all need to be considered.
Pathological fractures should be considered if there is not a significant history of
trauma.
Investigations
Initial radiographic imaging should include antero-posterior (AP) and lateral views
of the affected hip, as well as an AP pelvis (useful to assess the contralateral normal
hip for pre-operative planning and templating)*. Obtain full length femoral views if there
is suspicion of a pathological fracture.
Basic routine blood tests, including FBC, U&Es, and coagulation screen, are
required alongside a Group and Save; if a long lie time could have occurred, a
creatinine kinase level would be recommended to assess for any rhabdomyolysis.
A urine dip, chest radiograph (CXR), and ECG are all useful in complete
assessment of the older patient group, especially for pre-operative assessment and
peri-operative management.
*If there remains clinical equipoise about the diagnosis, repeat plain films whilst
manually applying traction to the affected leg or (more commonly) an MRI hip may be
warranted.
By TeachMeSeries Ltd (2019)
Figure 3 – Pelvic radiograph showing (A) R intracapsular hip fracture (B) L extracapsular hip fracture
Management
Initial management of a neck of femur fracture should consist of an A to
E approach to stabilise the patient (as for all trauma cases) – in particular as they are
often an unwell and frail group of patients.
Ensure adequate analgesia is provided, as well as early orthopaedic involvement.
There may have been a precipitating factor (do not assume all are due to UTI-related
confusion!), so a thorough assessment of potential underlying causes and contributing
conditions is essential.
Definitive management is surgical, specific procedures depending on the type of
fracture sustained. Non-operative conservative management is very rarely
recommended, as the benefits of surgical intervention nearly always outweigh the
potential conservative management.
Fracture Type
Surgical Option
Summary
Subcapital*
Hip hemiarthroplasty
Replacement of the femoral head and neck via
a femoral component fixed in the proximal femur
Intertrochanteric and
Basocervical*
Dynamic hip screw
Consists of a lag screw into the neck, a
sideplate, and cortical screws. The lag screw is
able to slide through the sideplate, allowing for
compression and primary healing of the bone.
Non-displaced intracapsular
Cannulated hip
screws
Three non-parallel screws in an inverted triangle
formation. Are also used in valgus-impacted
fractures
Subtrochanteric
Intramedullary
Femoral Nail
The metal rod is placed through the medullary
cavity of the femur for stabilisation
*Displaced intra-capsular fractures in normally well and active elderly patients with
high performance status can be treated with Total Hip Replacement, replacing both
the femoral head and neck (via a femoral component) and the acetabulum (via an
acetabular cup).
By TeachMeSeries Ltd (2019)
Figure 4 – A hip radiograph demonstrating cannulated hip screws in-situ
Immediate post-operative complications include pain, bleeding, leg-length
discrepancies, and potential neurovascular damage, all of which should be consented
for pre-operarively.
Post-operatively, NOF patients should be managed jointly under the care of the orthogeriatricians, ensuring to optimise the patients’ medical management. Best outcomes
are achieved with early rehabilitation, through engagement with physiotherapists and
occupational therapists.
Complications
Long term complications following repair include joint dislocation, aseptic loosening,
and peri-prosthetic fracture.
The mortality following a femoral neck fracture is up to 30% at one year.
Key Points

Neck of femur fractures are associated with a high one year mortality and the patient
cohort are often elderly and unwell with multiple comorbidities.

They will present as an acutely painful hip that is shortened and externally rotated.

Treatment of neck of femur fracture is primarily surgical. The specific procedure required
will depend on the classification of the fracture.

Ensure early assessment by ortho-geriatricians alongside physiotherapists and
occupational therapists.
Osteoarthritis (OA) is a degenerative joint disease characterised by loss of
articular cartilage, with an associated periarticular bone response.
It is extremely common, with prevalence increasing with age. It is the most common
cause of disability in the Western world in older adults.
The hip is the second most commonly affected joint in the body for osteoarthritis
and can be either unilateral or bilateral.
In this article, we shall look look at the risk factors, clinical features and management
of hip osteoarthritis.
By TeachMeSeries Ltd (2019)
Figure 1 – The articulating surfaces of the hip joint
Risk Factors
The risk factors for hip osteoarthritis can be categorised as systemic or local:
Systemic
Local

Increasing age (>45 yrs)

Obesity

Gender (women > men)

History of trauma to the hip

Genetics*

Anatomic abnormalities

Vitamin D deficiency

Muscle weakness/myopathy

Joint laxity

Participation in high impact sports
*Evidence shows there is an estimated heritable component of hip OA is between 5065%
Clinical Features
The majority of patients with hip osteoarthritis will describe a dull aching pain around
the hip, that can extend down the anterior thigh to the knee. It is aggravated by
activity and relieved by rest, and the joint may feel stiff after a period of immobility.
On examination, patients may have evidence of muscle wasting (in quadriceps and
gluteal muscles) and reduced power around the hip joint. A leg length
discrepancy or fixed flexion deformity may be present and patients can walk with
antalgic or Trendelenberg patterns.
Crepitus can be felt on passive movement and there is often a reduced range of
movement(both passive and active).
Differential Diagnoses





Trochanteric bursitis – presents with lateral hip pain radiating down the lateral leg, with
associated point tenderness over the greater trochanter
Gluteus medius tendinopathy – lateral hip pain with point tenderness over the muscle
insertion at the greater trochanter
Sciatica – low back pain and buttock pain, but often radiates down the posterior leg to
below the knee. Diagnosis is made with the straight leg raise to produce Lasègue’s sign
Avascular necrosis of the femoral head – there are likely to be risk factors involved in
the history (e.g. excessive steroid use, arterial disease etc) and radiographic changes will
also differ compared to that of OA
Femoral neck fracture – most commonly there will be a history of trauma or known
severe osteoporosis. The patient will be unable to weight bear due to pain and the limb
will appear shortened and externally rotated
Investigations
Hip osteoarthritis is a clinical diagnosis. However can be supported by radiographic
evidence (Fig. 2), which on a plain radiograph can include:




Narrowing of the joint space
Osteophyte formation
Sclerosis of the subchondral bone
Presence of cysts
Only one or two of these markers may be present; osteophyte formation tends to be
evident only in later stages of the disease.
Additional further imaging is rarely required, unless other diagnoses are being
considered.
By Mikael Häggström (Own work) [CC0], via Wikimedia Commons
Figure 2 – Plain radiograph showing features of severe hip OA
Classification of OA Progression
There are a number of different tools to classify the progression of OA.
The Western Ontario and McMaster Universities Arthritis Index (WOMAC) is a wellevaluated measure, which combines 5 items for pain (0-20), 2 items for stiffness (0-8)
and 17 items for function (0-68), giving an overall total out of 96.
This tool can be repeated to allow for a quantitative evaluation of disease progression.
Management
Initial Management
© World Health Organisation
Figure 3 – The WHO pain relief ladder, commonly used in the management of pain due to cancer.
Adequate pain control is important, using the WHO analgesic ladder (Fig 3), to
ensure ongoing mobility and quality of life.
Lifestyle modifications are also essential in aiming to improve self-management,
including weight loss, regular exercise and smoking cessation.
Physiotherapy is essential and should be provided for all individuals with hip OA,
aiming to slow disease progression and improving joint mechanics.
Long-Term Management
If conservative management efforts do not work, surgical intervention is warranted.
Definitive treatment is with a hip replacement*, either as a total hip replacement
(arthroplasty, Fig. 4) or a hemiarthroplasty. Several surgical approaches for these
procedures are available (see below)
*Recent developments have worked with hip resurfacing, whereby the femoral head
is preserved and capped with a smooth (metallic) surface and the damaged bone and
cartilage within the acetabulum is removed and replaced with a metal shell.
Common post-operative complications include thromboembolic disease, bleeding,
dislocation, infection, loosening of the prosthesis, and leg length discrepancy.
Adapted from X-ray Image ID 3684. Photographer: Unknown. [Public domain], via Wikimedia Commons
Figure 4 – Pelvic AP radiograph showing a right Total Hip Replacement
Surgical Approaches
There are a number of different approaches to hip replacement surgery that can be
taken, defined by their relation to gluteus medius:




Posterior Approach – The most common approach. Rehabilitation is often fast due to
preservation of the abductor mechanism, minimising the risk of abductor dysfunction post
operatively. However, there is the greatest risk of causing damage to the sciatic nerve.
Anterior Approach – This mechanism also avoids the abductor mechanism enabling a
fast recovery. There is a low dislocation rate due to the supporting musculature, however
there is around a 10% risk of sensory deficit in the distribution of the lateral femoral
cutaneous nerve.
Anterolateral Approach – The abductor mechanism is detached to allow excessive
adduction and thus full exposure of the acetabulum. A merit of this method is that the
superior retinacular vessels are not interrupted lowering the risk of avascular necrosis,
however there is a risk of damage to the superior gluteal nerve.
Lateral Approach – This requires reflection of the hip abductors. The muscles are often
divided at their tendinous portion. This approach has a lower dislocation rate than the
posterior approach however pain and weakness can remain post operatively.
Complications
A modern hip prosthesis is designed to last for 15-20 years; therefore, depending on
the age at time of replacement, it may never need revising.
Revision hip replacements are possible, but are subject to greater complication rates.
Key Points

The hip is the second most commonly affected joint in the body for osteoarthritis

Patients present with a dull aching pain, aggravated by activity and relieved by rest, with
associated joint stiffness, especially after a period of immobility

Diagnosis is made clinically however can be confirmed with a plain radiograph

Conservative management should be trialled initially, however if there is no improvement
then surgical intervention may be warranted
An anterior cruciate ligament (ACL) tear is a common injury to the knee joint, with
an incidence in the UK of around 30 cases per 100,000 each year.
The ACL is an important stabiliser of the knee joint, being the primary restraint
to limit anterior translation of the tibia (relative to the femur) and also contributing to
knee rotational stability (particularly internal).
Consequently, a tear of this important ligament often results in significant functional
impairment of the joint.
By TeachMeSeries Ltd (2019)
Figure 1 – Anterior view of the knee joint, showing the major knee ligaments
Aetiology
An ACL tear typically occurs in an athlete with a history of twisting the knee whilst
weight-bearing.
The majority of ACL injuries occur without contact and result from landing from a
jump, with the athlete not be able to continue playing thereafter.
Clinical Features
An ACL tear will typically present with a rapid joint swelling* and significant pain. If
the presentation is delayed, instability may also be evident, in which the patient
describes the leg ‘giving way’.
The specific clinical tests that can identify potential ACL damage are the Lachman
Test and Anterior Draw Test (see below).
*This is due to the ligament being highly vascular, hence the damage to the ligament
results in a haemarthrosis, being clinically apparent within 15-30 minutes
By TeachMeSeries Ltd (2019)
Figure 2 – Schematic demonstration of an ACL tear
Lachman’s Test and Anterior Drawer Test
Lachman’s test involves placing the knee in 30 degrees of flexion and, with one hand
stabilising the femur, pulling the tibia forward to assess the amount of anterior
movement of the tibia compared to the femur. The other knee is then examined for
comparison.
The anterior draw test involves flexing the knee to 90 degrees, placing the thumbs on
the joint line and their index fingers on the hamstring tendons posteriorly. Force is then
applied anteriorly to demonstrate any tibial excursion, which is then compared to the
opposite site.
Lachman’s test is the more sensitive of the two tests for an ACL tear.
Differential Diagnosis

Fracture

Meniscal tear

Collateral ligament tear

Quadriceps or patellar ligament tear
Investigations
A plain film radiograph of the knee (AP and lateral) should be taken to exclude bony
injuries, any joint effusion, or a lipohaemarthrosis present.
An MRI scan of the knee is gold-standard to confirm the diagnosis (>90% sensitivity),
also picking up any associated meniscal tears*
*50% of ACL tears will also have a meniscal tear, with the lateral meniscus the more
commonly affected
By Hellerhoff (Own work) [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia
Commons
Figure 3 – A MRI scan demonstrating a tear to the ACL
Management
As with any acutely swollen knee, the immediate management of a suspected ACL
tear is RICE (Rest, Ice, Compression and Elevation).
The specific treatment of an ACL rupture can be either conservative or surgical,
dependent on the suitability of the patient for surgery and their current levels of activity.


Conservative treatment involves rehabilitation, which utilises strength training of the
quadriceps to stabilise the knee. In the emergency setting, inpatient admission is rarely
required; the patient can often fully weight bear and a canvas knee splint can be applied
for comfort.
Surgical repair of the ACL (Fig. 4) involves the use of a tendon or an artificial graft. This
will always follow a period of ‘prehabilitation’, whereby the patient will engage with a
physiotherapist for a period of months prior to the surgery.
Adapted from Arthroscopist (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC BY-SA 4.0-3.0-2.52.0-1.0 (https://creativecommons.org/licenses/by-sa/4.0-3.0-2.5-2.0-1.0)], via Wikimedia Commons
Figure 4 – An arthroscopic reconstruction of right ACL ligament using an autograft
Complications
Post-traumatic osteoarthritis is a well-established complication of both ACL injury
and ACL reconstructive surgery.
Key Points

ACL tears typically occur in individuals following a twisting the knee whilst weight-bearing

Lachman’s Test and the Anterior Drawer Test are specific examinations for ACL damage

An MRI scan of the knee is the gold-standard investigation to confirm the diagnosis

The specific treatment of an ACL rupture can be either conservative or surgical
Posterior Cruciate Ligament Tear
A Posterior Cruciate Ligament (PCL) tear is a less common injury to the knee join.
The PCL is the primary restraint to posterior tibial translation and works to prevent
hyperflexion of the knee.
PCL tears typically occur in high-energy trauma, such as a direct blow to the proximal
tibia during a RTA, or less commonly in low-energy trauma when there is hyperflexion
of the knee with a plantar-flexed foot.
Clinical Features and Investigations
A torn PCL will result in immediate posterior knee pain. There will be
an instability of the joint and a positive posterior draw test (with a posterior sag) on
examination.
As with ACL tears, the gold-standard for diagnosis for PCL tears is via MRI scanning.
Management
PCL tears can often be treated conservatively in the first instance with a knee brace
and physiotherapy. If the patient continues to be symptomatic and has recurrent
instability of their knee joint then they may require surgery with insertion of a graft.
If it is associated with other injuries, such as meniscal tears, then these may need to
be treated surgically more urgently.
The tibial plateau most commonly fractures following high-energy trauma, such as
a fall from height or a road traffic accident, from the impaction of the femoral
condyle onto the tibial plateau. Less commonly they occur in elderly patients following
a fall, especially those with osteoporosis.
It is typically a varus-deforming force, meaning that the lateral tibial plateau is more
frequently fractured than the medial side. They are often found alongside other bony
and soft tissue injuries, such as meniscal tears or cruciate or collateral ligament
injury.
It is important to recognise that this is a significant injury, as there is disruption of the
congruence of the articular surface that, if left, will lead to rapid degenerative
change within the knee.
By TeachMeSeries Ltd (2019)
Figure 1 – The tibial plateau
Clinical Features
Patients will present following a history of trauma. A clear history of the mechanism
of injury is important, as an injury through axial loading or high-impact injuries will
increase the likelihood.
Patients will present with sudden onset pain in the affected knee, being unable to
weight-bear, and associated with swelling of the knee*.
On examination, significant swelling will be evident, alongside tenderness over the
medial or lateral aspects of the proximal tibia, with potential ligament
instability (albeit not clinically assessed initially, due to the pain it would cause).
Ensure to check peripheral neurovascular status of the patient, as neurovascular
injuries (such as popliteal vessel dissection or common fibular nerve damage) are an
important association of high grade injuries.
*This represents a lipohaemarthrosis and is an important clinical and radiological
feature to recognise
Differential Diagnosis
For patients presenting with knee pain following trauma, other differentials to consider
are knee dislocation, other knee fractures (including patella or distal
femur), meniscal injuries, ligamentous injuries, patella dislocation, or
patella/quadriceps tendon rupture.
Investigations
The first line investigation for a suspected plateau fracture is plain film
radiographs(anteroposterior and lateral), often features on radiograph are subtle (Fig.
2). There will also be a lipohaemarthrosis present.
CT scanning is needed in almost all cases (Fig. 3), apart from undisplaced fractures.
This help both in assessment of severity, as well as surgical planning.
*It is important to recognise that the presence of fat in the joint indicates that there is
an intra-articular fracture present (e.g. tibial plateau, patella, distal femur)
James Heilman, MD [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]
Figure 2 – Plain radiograph showing tibial plateau fracture
Classification
Tibial plateau fractures can be classified through the Schatzker Classification
Fracture Type
Description
Type I
Lateral split fracture
Type II
Lateral split – depressed fracture
Type III
Lateral pure depression fracture (rare)
Type IV
Medial plateau fracture
Type V
Bicondylar fracture (rare)
Type VI
Metaphyseal – diaphyseal disassociation
Table 1 – Schatzker Classification for tibial plateau fractures
Management
Conservative Management
Non-operative management can be trialled in uncomplicated tibial plateau
fractures(including no evidence of ligamentous damage, tibial subluxation, or articular
step <2mm)
These can typically be treated with a hinged knee brace and non- or partial-weight
bearing for around 8-12 weeks, alongside ongoing physiotherapy and
suitable analgesia.
Operative Management
James Heilman, MD [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)]
Figure 3 – CT imaging demonstrating lipohaemarthrosis due to a tibial plateau fracture
Operative management is typically warranted in complicated tibial plateau
fractures*, or any evidence of open fracture or compartment syndrome. Any form
of medial tibial plateau fractures may also require surgical intervention, even if
undisplaced, as they have a great potential for displacement.
Open reduction and internal fixation (ORIF) is the mainstay of most tibial plateau
fractures, with the aim to restore the joint surface congruence and ensure joint
stability. Any metaphyseal gaps can be filled with bone graft or bone substitute.
Postoperatively, a hinged knee brace is fitted with early passive range of movement
but limited or non-weight bearing for around 8-12 weeks months is typically required.
External fixation may also be warranted, with delay to any ORIF, especially in cases
of significant soft tissue injury or in polytrauma / highly comminuted fractures where
an ORIF may not be suitable.
*Complicated fractures include those demonstrating an articular step ≥2mm, angular
deformity ≥10 degrees, any metaphyseal-diaphyseal translation, ligamentous injury
requiring repair, or those with associated tibial fractures.
Complications
The main long-term complication following a tibial plateau fracture is post-traumatic
arthritisto the affected limb.
Key Points

Tibial plateau fractures commonly occur following high-impact trauma

Ensure to check the neurovascular status of the affected limb

Initial imaging is via plain radiographs, however definitive treatment often requires CT
imaging

Open reduction and internal fixation is the mainstay of most tibial plateau fractures that
require surgery