Here is a new case by Dr. Nicholas Frane (Broken Bone Doc) and Allina Health. TIBIAL PLATEAU AND EMINENCE FRACTURE IN 22F How would you manage this #orthotwitter? Vote on this case for CME:

HPI: The patient is a 22-year-old female who presents with knee pain. She fell during soccer approximately 6 days ago and was seen in urgent care. She reports it felt like she hyperextended her knee at the time of the injury. She was placed in a knee immobilizer and has been non-weight-bearing since her injury. PMH: She is otherwise healthy. PE: On physical exam, she is tender to palpation around the knee medial and posterolaterally. She has a knee effusion. She is swollen, however, the skin remains pliable and she does not have any blisters or wounds present around the knee. Pain limits her ligamentous examination.Her sensation is intact to light touch in all dermatomes. There is no pain to passive stretch. She has 5/5 strength in ankle dorsiflexion, plantarflexion, EHL, FHL. Palpable dorsalis pedis and posterior tibial pulse.

Here are the pre-operative CT scans.

@yoon_rs @Trauma_Pagaza @DeformityDoc @cj_footeMD @Drlyndonmason @DrTaksali @schulte_ss @bonesmith_ @davidhcmd Here are additional pre-operative CT scans and videos.

@yoon_rs @Trauma_Pagaza @DeformityDoc @cj_footeMD @Drlyndonmason @DrTaksali @schulte_ss @bonesmith_ @davidhcmd Here are additional MRI videos.

If you choose Open Reduction and Internal Fixation (ORIF), how would you manage the ACL footprint?

I think meniscal root is still attached. Is easy to assess intraop. ACL footprint fragment can be transfixed or inside out fibertape over a cortical endobutton. Done both, both work. Articular fragment is bizarre. Probably do femoral epicondyle osteotomy and fix with PLLA pins. Fixing from the back will suck. Can address meniscus with the osteotomy too.

Many things to consider for this injury. Is this injury best assessed with an MRI for the ligaments and soft tissues? How would you handle this kind of fracture? Ortho trauma or sports medicine territory? @rkh_md @EauClaireOrtho @traumaticum @H2O_SportsMD @sportsdoc2016 @RachelFrankMD @EdinburghKnee @Liverpool_Ortho @sportsdrsean @BoneJointDoctor @MSOSOrtho @itius @kneedoclond @schulte_ss @orthogal21 @hassanfarooqMD @TylerWillOrtho @morrisonMSK @northwoods1980 @willtheyplay @jocktodoc @DrJN_SportsMed @DrNiravPandya

@DrFraneNicholas @AllinaHealth @traumaticum @rkh_md @DrMarecek @jamesablairMD @FractureDoc @stevemchale @xlgriffin @docfarrow @InvictaOrtho @lisacannada Combo ORiF and either scope assisted reduction of ACL footprint and art surface or mini open using an assortment of FiberRings and ACL Tightrope for ACL Avulsion, and Tightropes with button sandwich for art surface. Just removed buttons on sililar one yesterday.

@DrFraneNicholas @AllinaHealth @rkh_md @DrMarecek @jamesablairMD @FractureDoc @stevemchale @xlgriffin @docfarrow @InvictaOrtho @lisacannada found the one on ORIF with the arthro suture/endobutton reduction

@DrFraneNicholas @AllinaHealth @traumaticum @rkh_md @DrMarecek @jamesablairMD @FractureDoc @stevemchale @xlgriffin @docfarrow @InvictaOrtho @lisacannada Yikes that is an interesting pattern! Where sports and trauma collide! @DifeliceMD @drcalcei @bennwachukwumd and see what they would do for it.