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December 27th, 2018
X-ray of the knee

In this section are going to learn how to detect subtle tibial plateau fractures. Tibial plateau fractures have important clinical implications and can be commonly missed if you don’t recognize the important sign used to detect these fractures.

Take this frontal view of the knee:

X-ray of the knee

As you can see there is no sign of an obvious fracture.

Now look at this oblique view:

X-ray of the knee

Again, there is no obvious sign of a fracture.

Now let’s look at the 3rd and last view, the lateral view

X-ray of the knee

Again, there is no obvious fracture. But you can now see a large knee effusion (fluid in the joint). More importantly, you see 2 different density levels clearly separated and delineated by the arrows shown below.

X-ray of the knee

So what we have is called lipohemearthrosis of the knee joint which is essentially synonymous for a tibial plateau fracture. The concept of lipohemearthrosis is a very important one.

First let’s look at the meaning.

Lipo: fat
Heme: blood
Arthrosis: joint

So that means you have fat and blood in the knee joint. Let’s look at how that happens.

When you have a fracture of the tibial plateau, the bone marrow, which is composed of blood and fat, actually escapes from the fractured cortex and shoots up into the knee joint. The knee effusion is composed of blood and fat, hence lipohemearthrosis.

X-ray of the knee

The red arrow is an example of the bone marrow shooting up to the knee joint once the cortex of the bone has been breached and fractured.

The fat and blood, because of their different densities, will separate and layer, especially in an injured immobile patient. So by the time the X-ray is done in the urgent care or the emergency room, the two layers will have likely separated and can be delineated. Once you see lipohemearthrosis, you have to strongly suspect a tibial plateau fracture and even if you do not an obvious fracture on the X-ray.

At this point, you have to take the next step and order a CT scan or MRI to detect the fracture. Usually a CT scan is performed since it is faster and more available in the emergency setting.

X-ray of the knee

The knee effusion is composed of 2 separate densities made of blood and fat.

So the next Step is to a CT scan. Please watch my video as it will take you through multiple fractures of the tibial plateau displayed on CT that could not be identified by these X-Rays.

So, in conclusion, the only sign that helped us have a high index of suspicion for a radiographically occult fracture was the finding of lipohemearthrosis. Next time you encounter a large effusion in a patient with history trauma, make sure to look for this sign. If your index of suspicion is high, you can either get an additional cross table lateral X-Ray view of the knee to help see the fat-fluid level or just recommend a CT scan.

X-ray of the knee

 

CT scan image showing one of the fracture sites. Please refer to the video to see all of the fractures.

Posted on behalf of Advanced Healing Institute

22972 El Toro Road
Lake Forest, CA, 92630

Phone: (949) 239-3206

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Advanced Healing Institute

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Rich G.

Dr. Reza is a genius. My knee has been bothering me for YEARS since I tore my meniscus playing football. Achy, bothersome, with occasionally a limp. I went in to to get PRP (Platelet Rich Plasma) and it was everything I thought it would be and then some. The whole procedure took less than an hour, very little to no pain and in less than 24 hours my knee felt brand new. If you are looking for a quality Doctor who offers PRP -- go here! The rates are very on point. He is literally THOUSANDS of dollars less than some other clinics and believe me he does such an amazing job, he could charge 10x's and it would still be worth it. Don't sit there suffering, get up and get help. I am actually thinking of getting my other knee done and its not really necessary. Lol.. 10 STARS...

E Y.

Dr Reza is FANTASTIC. Staff is friendly and very accommodating. I was in such pain. He diagnosed the issue (Bursitis) and clearly understood everything about it from A-Z. So efficient and understanding, not to mention making the procedure painless. I barely slept a hour the night before, saw Dr. Reza at 5pm and was feeling a million times better by 7pm. It's been 36 hours and I went from practically a frozen shoulder in pulsating pain to gaining back 70% of my movement range and most importantly "NO PAIN". just stiffness which is the normal symptoms as kindly explained to me by Dr. Reza. Everything is as promised, I am fully confident that I will be back to 100% range of motion within 3 days. I'm still gonna take it easy and slowly stretch my shoulder back to full strength. Without his service, I would probably be feeling like I was hit by a truck laying in bed miserable. Thank you very much Dr. Reza for helping my aging old bones. Cheers!

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Had the PRP procedure and I have to say no pain at all, going on 6 weeks, if you decide to have the PRP listen to Dr. Dehdari's instructions thoroughly and do the physical therapy, it works and I am so pleased and it's getting better and better as days go on, Dr. Reza Dehdari is the best and very emphatic in explaining all your questions soothing away your doubts, and he checks up on you to make sure all is well, after the PRP procedure. Very trustworthy PRP procedure and his assistant Sandy is also the sweetest caring person you will ever meet. I'm a satisfied customer and patient.

Micheal W.

Dr. Reza Dehdari you are an amazing person. Thank you for going the extra mile on my shoulder after three Doctors told me I needed surgery. You took your time and explained everything about what to expect and to be patient while I heal. And that’s exactly what I did was heal, I can’t thank you enough for what you did for me.

Helena L.

Within the last 6 months I've suffered two minor injuries on the same knee which have restricted my mobility and caused me a lot of pain. I've seen an orthopedic dr.,, a pain management dr., and a sports medicine dr., all of which simply told me either surgery or learn to live with the pain! I've heard about PRP as an alternative with a high percentage of success. Thus, I made an appointment to see Dr. Dehdari, and was pleasantly surprised by his high level of knowledge, professionalism and thoroughness. Dr. Dehdari reviewed my MRI (previously ordered by the Orthopedist) explained the extent of my injuries, took X-Rays and an ultrasound to carefully determined if I was a good candidate for PRP. I can only say that I wish more doctors will give you the time, attention and care that Dr. Dehdari provides. Thank you Dr Dehdari, thank you for such high work ethics and patient care. Many thanks to his staff as they are as attentive and caring as Dr. Dehdari. It has been only 24 hrs since I received my PRP treatment and my pain levels have drastically gone down! I highly recommend Dr. Dehdari.

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