45 year old female presents to the ED after a motorcycle accident, complaining of leg pain. EMS splinted the affected extremity prior to arrival, and state pulses were present prior to application of the splint. On arrival to the ED, as you await a room to become available, you take the patient to xray and obtain the image seen below. What's the diagnosis? Scroll down for answer.

Answer: Tibial plateau fracture (as well as distal tibia fracture, and multiple fibular fractures)

• Classification
• Schatzker Type VI - ie, complete dissociation of metaphysis & diaphysis
• See a more extensive review of this classification here
• Complications
• Popliteal artery or peroneal nerve injury
• Compartment syndrome (especially if fracture is due to high energy mechanism)
• Management
• Evaluate for possibility of vascular injury (use doppler if needed to confirm presence of pulses)
• Evaluate for possibility of compartment syndrome (especially with high energy mechanism)
• Orthopedic consultation - will require ORIF

References:

• Berkson EM, Virkus WW. High-energy tibial plateau fractures. J Am Acad Orthop Surg 2006; 14:20-31. PMID: 16394164
• Tintinalli, JE. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 8th ed. New York, NY: McGraw-Hill Education LLC, 2016.