Videos of Professor Nima Heidari
case takeaways - tibial plateau malunion, when to consider a corrective intra-articular osteotomy
Description:
Professor Nima Heidari joins us to talk us through the tibial plateau malunion case. 43 yrs male. Fall 40m off a mountain in Ecuador 1 year ago. Right femur fracture and L1 burst fracture treated with fixation at the time (healed well). Left tibial plateau fracture was missed at the time. He has bilateral foot drops, treated with AFO’s. Main ongoing complaint is left knee pain What do you suppose the mechanism of injury here was? Axial compression Pure varus Varus and hyperextension Varus and flexion Pure valgus Valgus and hyperextension Valgus and hyperflexion Why do you think this patient has knee pain (the primary reason)? Because there is valgus deformity and lateral overload/instability Because there is varus instability and medial overload/instability Because he has impending post-traumatic OA Because his lateral meniscus is likely jammed in the old fracture crevice Likely neurological pain related to his spine and foot drops He's a terrible moaner and needs to be discharged. CT of the knee is done (shown). What (single) most useful investigation would you want to plan Tx? MRI Knee Long leg alignment views X-ray of contralateral knee X-rays of the hip and femur Psych referral