Thread by @traumaticum

I've got 2 patients in orbit with concomitant fibula fractures (PLC injuries) in context of tibial plateau fracture. PLC anatomy does my head in, so heres a list of what im reading. If anyone has some tips on management of these, please chime in! #orthotwitter

pubmed.ncbi.nlm.nih.gov/27620470/
pubmed.ncbi.nlm.nih.gov/26535398/
pubmed.ncbi.nlm.nih.gov/33392754/
pubmed.ncbi.nlm.nih.gov/12540438/

and whilst i agree neck injuries heal (and rarely need to be actively managed) im concerned about these 2 specific cases in that the PLC is identifiably disrupted as a descrete structure/complex, and a posterolateral instabilty ist quite likely (though not testable at present)

first up, thanks for all the replies. I had the more complicated one on the table this afternoon, and was good to have digested a few opinions before stepping up to the plate. dissected the corner apart and mobilised CPN, then did lateral articular recon before reassesing ⬇️

once everything was out to length the whole PLC had incredible tension despite the bony foundation being smashed. Biceps had a 75% tibia insertion which also held the bony LCL insertion piece solid. the popliteofibular/arcuate corner felt similar, and I couldnt induce PLRI at all

Ill post a proper thread with this later... just gets me the images off my work computer for the time being...

Here’s the LCL doing it’s thing after reduction of the lateral joint surface @SportsOrthoUK @kneedoclond @brunovdk1 @txsportsdoc

And photo for photo’s sake… the entire lateral plateau basically fell out of the wound. Here’s the fibula articulation… don’t see that every day. The photos in the hole didn’t work, but could see the PLC from the inside. Very cool in a disturbing kind of way