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.

 TIBA3

Management:

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.

TIBA4