무릎 주위 골절의 끝판왕, 경골 고평부 골절｜성공적인 수술 치료 케이스

#Fracture #FractureSurgery #LegFracture #KneeFracture #Orthopedics Hello. I am Han-ju Kim, a specialist in orthopedics and a subspecialist in traumatology. Today, I will explain the tibial plateau fracture, which is commonly referred to among orthopedic surgeons as the "ultimate" type of fracture around the knee. First, to explain the term "plateau," it means a "highland" or a "high and flat structure." It refers to the flat articular surface located at the very top of the tibia that forms the knee joint. When a fracture occurs in this area, it is difficult to treat because it involves the joint. Furthermore, it is a fracture with a high probability of leading to post-traumatic osteoarthritis, which can result in a poor prognosis. Traditionally, the Schatzker classification is used for tibial plateau fractures. Type 1: Lateral condyle split Type 2: Lateral split and depressed fracture (split depression) Type 3: Central depressed fracture (central depression) Type 4: Medial condyle split Type 5: Bicondylar fracture Type 6: Metaphysis-diaphysis dissociation Type 2 is the most common form in clinical practice. Types 5 and 6, in particular, are often caused by strong external forces and are frequently accompanied by severe soft tissue damage. In such cases, the risk of compartment syndrome increases, and emergency fasciotomy may be necessary if severe pain, paresthesia, or paralysis symptoms appear. Compartment syndrome is an emergency condition that requires a rapid response in orthopedics, as delayed treatment can lead to muscle necrosis, nerve damage, infection, and, in severe cases, even amputation. When viewing the tibial plateau from above, the three-column classification can be applied along with the Schatzker classification. Identifying which of the three pillars—anterolateral, anteromedial, and posterior (medial/lateral)—is damaged is crucial for planning the surgical approach and fixation method in advance. The most critical aspect of a tibial plateau fracture is precisely aligning the articular surfaces without any gaps. This is because failure to align them properly significantly increases the risk of developing post-traumatic arthritis. 📌 Case: Female in her 40s / Pain developed after her knee twisted while falling while skiing. Examination confirmed a Schatzker Type 2 tibial plateau fracture, characterized by a depressed lateral articular surface. The surgery involved reducing the depressed articular surface by lifting it from below upward using an instrument called an Impactor. Lifting the depressed area creates an internal void; this space was filled with bone chips to provide support and prevent the bone from sinking back down. Subsequently, the fracture was firmly fixed using a metal plate and screws. Post-operative X-rays and CT scans confirmed that the joint surfaces were precisely aligned. Knee joint exercises began immediately on the 1st or 2nd day after surgery, and weight-bearing walking with crutches was performed starting from the 1st week. By the 7th week post-surgery, the patient had recovered enough to perform squats and walked very naturally. ✅ Today's Conclusion ✔️ Tibial plateau fractures involve the knee joint and are very tricky and difficult to treat. However, if the joint surfaces are accurately aligned and stably fixed, good functional recovery and a favorable prognosis can be expected. We will continue to deliver accurate and practical medical information through real-life cases. Thank you for watching. 📌 Please leave any questions regarding fracture union, nonunion, or revision surgery in the comments. 😊