Medial ve bikondiler tibia plato kırıkları

Özet

Medial kondil veya bikondiler plato kırıkları yüksek ya da düşük enerjili travmayla oluşabilir; yüksek enerjili yaralanmalarda daha karmaşık kırık örüntüsü beklenir. BT tabanlı kırık haritalaması, plato kırık çizgilerinin aksiyel, koronal ve sagittal düzlemlerde dağılımını değerlendirmeye olanak verir. Metafiz-diafiz devamlılığının kopması, bikondiler kırığı metafiz-diafiz ayrışması bulunan bir patern olarak tanımlar. Bikondiler kırıklarda posteromedial fragman farklı serilerde %30 ile yaklaşık %65 arasında bildirilmiştir; bu ve diğer posterior fragmanların değerlendirilmesi tedavi stratejisini etkileyebilir.

Faz ve pencere

Kontrastsız tanısal

Koronal, aksiyel ve sagittal BT değerlendirmesi kırık çizgilerinin farklı düzlemlerdeki dağılımını gösterir.

Önerilen pencereler: Kemik (G 1800 / M 400), Yumuşak doku (G 400 / M 40).

BT bulguları

• Medial kondil kırığı — medial eklem yüzü ve kondil içinde vertikal veya oblik ayrışma çizgisi izlenir.
• Bikondiler tutulum — medial ve lateral plato kondillerini birlikte içeren kırık örüntüsüdür.
• Posteromedial fragman — koronal hatta sınırlı görünse de aksiyel kesitlerde arka korteks boyunca ayrı eklem parçası oluşturabilir.
• Posterior shear kırığı — posterior kolonda eklem çökmesi ve posterior duvar kırığı ile tanımlanır.
• Metafiz-diafiz ayrışması — eklem taşıyan proksimal fragman ile distal tibia şaftı arasında kortikal devamlılık kaybolur.
• İnterkondiler eminens kırığı — tibial eminens, tip C plato kırıklarında sıklıkla tutulabilir.
• Fibula başı avulsiyonu — lateral bağ kompleksi yapışma yerindeki küçük kemik parçası eşlik eden yaralanmayı gösterir.
• Lipohemartroz — eklem içi yağ ve kan katmanlanması eşlik eden intraartiküler kırığı doğrular.

Ölçütler ve sınıflamalar

Schatzker

Tip IV medial plato kondil kırığıdır; tip V bikondiler kırıkta eklem taşıyan metafiz-diafiz bağlantısı sürer; tip VI bikondiler kırıkta metafiz-diafiz ayrışması vardır.

AO/OTA 41

B tipi parsiyel artiküler, C tipi tam artiküler proksimal tibia kırığıdır; C grubunda eklem yüzü ile diafiz arasında devamlılık kaybolur.

Üç kolon sınıflaması

Proksimal tibia üç kolon (lateral, medial, posterior) olarak modellenir; her kolonda bağımsız eklem fragmanı varsa üç-kolon kırığı kabul edilir ve tedavi yaklaşımı buna göre planlanır.

Normalde

Normal proksimal tibia eklem yüzünde medial ve lateral plato korteksleri kesintisiz, tibial eminens ortada ve metafiz korteksi diafize devamlıdır. Aynı koronal kesitlerde iki kondilin yüzey bütünlüğünü, aksiyel kesitlerde posterior duvarı ve sagittalde eklem taşıyan fragmanın şaftla bağlantısını kontrol edin.

Ayırıcı tanı

İzole lateral split-depresyon

kırık yalnız lateral kondili tutar; medial plato ve şaft bağlantısı sağlamdır.

Posterior shear kırığı

posterior kolonda eklem çökmesi ve posterior duvar kırığıyla tanımlanır; bikondiler kırıkta medial ve lateral kondiller birlikte tutulur.

Segond avulsiyonu

anterolateral plato altındaki küçük kortikal kopmadır; medial kondil veya iki kondil boyunca uzanan kırık değildir.

Tuzaklar

• Tek AP grafi kırık fragmanlarını tam olarak tanımlamayabilir; BT, kırık örüntüsünü daha ayrıntılı değerlendirmeye olanak verir.
• Eklem taşıyan blok ile distal şaft ilişkisini yalnız eklem seviyesinde değerlendirmeyin; metafiz-diafiz ayrışması koronal ve sagittal planda ortaya çıkabilir.
• Schatzker tipi posterior kolon morfolojisini tam kodlamaz; sınıfı yazdıktan sonra arka fragmanın tarafını ve kortikal duvar durumunu metinde belirtin.

Kendini dene

1. Her iki tibia plato kondili kırılmış, ancak eklem taşıyan metafiz parçası diafizle bağlantısını koruyor. Schatzker tipi hangisidir?

   • Tip V
   • Tip IV
   • Tip VI
   • Tip II
   Cevabı göster

   Tip V. Tip V bikondiler eklem kırığıdır ve metafiz-diafiz devamlılığı korunur. Tip VI'da bu bağlantı ayrılır; tip IV medial kondili, tip II lateral split-depresyonu tanımlar.

2. Bikondiler kırıkta aksiyel BT posterior kortekse ulaşan ayrı posteromedial eklem fragmanını gösteriyor. En doğrudan sınıflama kavramı hangisidir?

   • Posterior kolon tutulumu
   • Saf lateral split
   • Segond avulsiyonu
   • Tibial eminens kırığı
   Cevabı göster

   Posterior kolon tutulumu. Ayrı arka eklem fragmanı ve posterior duvar kopukluğu posterior kolon tutulumunu tanımlar; lateral split kırıklar Schatzker Tip II'yi oluşturur; Segond avulsiyonu anterolateral plato tabanındaki kortikal kopmadır; tibial eminens kırığı ise interkondiler çıkıntı merkezli bir avulsiyondur.

İlgili konular

• Diz lipohemartrozu
• Tibia platosu posterior shear/kolon kırığı
• Segond avulsiyon kırığı

Kaynaklar

Bu sayfadaki 39 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 12 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.