Abstract
Moore type I posteromedial split fracturedislocation of proximal tibia are relatively uncommon. It is a specific fracture pattern that is not well described by the AO (41B2.2/B3.2) or Schatzker (IV) classification system because these systems do not differentiate when the medial fragment is primarily posterior and associated with a dislocation as the Moore system does. 1The additional use of computed tomography scans in the assessment of tibial plateau fracture may improve surgeon’s agreement that lead to the final decision and optimization of treatment. 2Galla and Lobenhoffer described a direct posteromedial approach for managing Moore type I tibial plateau fracture1.
Report:
A 48 years old malay gentlemen was alleged motor-vehicle accident, sustained closed fracture tibial plateau of right knee. Initially patient was diagnosed with right tibial fracture schatzker IV based on right knee anterior-posterior and lateral view xray. But CT scan had done, show the proximal tibial fracture transversing medial aspect with coronal spliting. Patient was treated with posteromedial locking compression plate with Lobenhoffer approach. Intraoperatively, diagnosis was confirmed with Hohl & Moore classification type I, there is coronal split fracture extending to posteromedially. The importance of computerised tomography scans when dealing with intra-articular fracture of tibial plateau may improve regarding localisation of fracture lines, depression zone, comminution, and the surgical treatment plan. 2Alexander et al. reported after addition of computerised tomography scans significantly improved to “good” in all classification. The features of Moore’s type I fracture which is coronal split fracture dominantly posterior column, coronal view from CT scans is more useful compare than sagital view. Galla and Lobenhoffer have introduce a direct postero-medial approach that minimizes soft tissue injury while allowing excellent fracture visualization, reduction, and fixations. 1This technique protect the neurovascular bundle and requires only suboeriosteal elevation of the popliteus to obtain full exposure. Furthermore, because of the protecting posterior soft tissues, skin closure and wound healing are reliable.
Conclusion:
Moore’s type I fracture managed with postero-medial approach has better post operative outcome, improved reliability and shows good reproducibility when classified with computerised tomography scans.
References:
Johannes K.MF, et al,. Optimizing the Management of Moore Type I Postero-Medial Split Fracture Dislocations of the Tibial Head: Description of the Lobenhoffer Approach. J Orthop Trauma 2007;21:330-336 Alexander B, et al. Classification system for tibial plateau fractures: Does computed tomography scanning improve their reliability? Injury, Int. J. Care Injured 41 (2010) 173-178