Diagnosis

Partial articular fracture, split (AO/OTA 41B1) 

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Partial articular fractures with a condylar split are classified by the AO/OTA as 41B1 fractures. The prognosis depends on whether the fracture involves the lateral or the medial articular surface. It is generally poorer for medial fractures.

In the older patient, these fractures may be due to low velocity trauma because the bone is very osteoporotic. Surgical stabilization may therefore be very difficult.

Options
1. Split of the lateral surface (AO/OTA 41B1.1) 
2. Split of the medial surface (AO/OTA 41B1.2) 
3. Oblique split, involving the tibial spines and one of the tibial plateaus (AO/OTA 41B1.3) 

1. Split of the lateral surface (AO/OTA 41B1.1) 

Split of the lateral surface (AO/OTA 41B1.1)

Split of the lateral surface (AO/OTA 41B1.1)

X-rays taken from Orozco R et al, (1998) Atlas of Internal Fixation. Used with kind permission.

2. Split of the medial surface (AO/OTA 41B1.2) 

Split of the medial surface (AO/OTA 41B1.2)

The medial plateau fractures are rare and often occur as a result of high-energy force. They may be associated with knee joint dislocations, meniscal tearas, compartment syndrome, ligament ruptures and avulsions, and occasionally serious neurovascular injuries such as tearing of the peroneal nerve and lesions of the popliteal artery.

Split fractures of the medial tibial plateau are classified by the AO/OTA as 41B1.2 fractures.

Split of the medial surface (AO/OTA 41B1.2) Split of the medial surface (AO/OTA 41B1.2)

3. Oblique split, involving the tibial spines and one of the tibial plateaus (AO/OTA 41B1.3) 

Oblique split, involving the tibial spines and one of the tibial plateaus (AO/OTA 41B1.3)

The medial plateau fractures are rare and often occur as a result of high-energy force. They may be associated with knee joint dislocations, meniscal tearas, compartment syndrome, ligament ruptures and avulsions, and occasionally serious neurovascular injuries such as tearing of the peroneal nerve and lesions of the popliteal artery.

Oblique split, involving the tibial spines and one of the tibial plateaus (AO/OTA 41B1.3)

X-rays taken from Orozco R et al, (1998) Atlas of Internal Fixation. Used with kind permission.