Occult tibial plateau fracture

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A 19-year-old male university level collegiate player sustained an acute injury to his left knee after a collision with an opponent.  The injury involved a direct blow to the lateral aspect of the knee. The player had immediate pain but was able to weight-bear and attempted to continue playing for a short time. Eventually he had to leave the field due to pain and the knee swelled within a few minutes.  There was no history of prior knee injuries.  A clinical examination conducted on the sidelines demonstrated a moderate effusion, tenderness along the lateral aspect of the knee and no ligamentous laxity.

X-rays of the left knee including AP, lateral, notch and skyline views, were obtained in clinic the following day.  These showed a subtle cortical irregularity at the lateral aspect of the posterior and lateral tibial plateau.  Further imaging with MRI demonstrated a non-displaced fracture involving the lateral tibial plateau with intra-articular extension (illustrated by the arrows) and pronounced increased signal associated associated with this (illustrated by the star).

The day following the injury the player had a tense effusion. The knee was aspirated to provide pain relief (with 130 ml of blood being removed).  After the diagnosis was made, the player was treated conservatively with non-weightbearing for 3 weeks followed by progressive weight-bearing and rehabilitation. He was able to return to play two months following the injury.

The differential diagnosis for a traumatic haemarthrosis of the knee includes injuries to the anterior cruciate ligament (ACL), patella instability, fracture or osteochondral injury, and occasionally a peripheral meniscus tear.  This case illustrates the need to carefully evaluate a player who presents with rapid knee swelling as this history suggests a significant knee injury.  A careful clinical assessment is always needed.  X-rays are frequently normal and should not falsely reassure the medical team. In most cases MRI is indicated for further investigation.

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05 octobre 2018 15:19

Le traumatisme du GENOU doit être pris au serieux quelque soit la forme.lorsque le trauma survient au cours d une activité sportive le médecin du sport doit imposer au sportif l arrêt de toute activité et lui faire comprendre qu’ en continuant à jouer il s exposé à des dégâts. Le conduire en clinique pour examen. L examen du GENOU se repose. 1 sur le test de laterite( LLI- LLE et MENISQUE) 2 Tiroir. 3 Les ligaments croisés.. S il y’a un epanchement quelque minute apres(HEMARTHROSE) il faut faire une ponction evacutrice pour soulager le sportif. Demander en urgence une… Lire la suite »

06 avril 2020 11:53