Case in the Spotlight 19 - Answer & Discussion
A review of the plain XR below demonstrates the fat-blood level seen on a horizontal XR. This evidence of lipohaemaethrosis is highly suggestive of an intra-articular fracture.
Tibial plateau fractures can be subtle on plain radiography so clinical and radiological assessment looking for effusion and haemarthrosis is very helpful in diagnosis.
You (a) provide excellent analgesia and immobilisation, ensure AMPLE history, neurovascular assessment, and ensure the patient remains fasted.
(b) discuss with a senior doctor in the Emergency Department, and the orthopaedic team.
A CT was performed for this patient. As can be seen on the below image, the fracture extended into the tibial plateau.