Stahl et al have published an article in the July 2015 JOT titled “Operatively Treated Meniscal Tears Associated With Tibial Plateau Fractures: A Report on 661 Patients.”
The authors presented a series of patients with tibial plateau fractures and meniscal injuries. They found the rate of fractures with meniscal injuries requiring repair to be 30% and 45% with split depressed fractures. They felt this rate was lower than previously reported and that advanced imaging of tibial plateau fractures to overstate the true incidence of meniscal tears requiring intervention.
The information on the rate of meniscal injuries requiring repair at 30% and most often with split depressed fractures (45%) is more good information to maintain an index of suspicion for this injury.
What is not acknowledged as was noted in Gardner et al (J Orthop Trauma. 2005;19:79–84) was there can be medial meniscus injuries especially with significant depressed lateral fractures and the higher energy injuries. With a Schatzker IV essentially being a knee dislocation, there can be an expected incidence of soft tissue injury accompanying this. And often times a medial arthrotomy is not completed with fixation of IV, V, VI fractures so one must maintain a high index of suspicion or consider advanced imaging in appropriate, select cases.
I agree with the authors that direct visualization of the meniscus is useful to guide the treatment.
Lisa K. Cannada, MD
Department of Orthopaedic Surgery
Saint Louis University