Mr. Yagogo
Mr. Yagogo had a bad day. Well I guess he probably had a pretty bad week. Mr. Yagogo, a 26 year old otherwise healthy male, presented on December 16th, about 1 week after being involved in a mining accident. He states he was working in the mines when some large boulders fell on top of him, knocking him to the ground. He was primarily hit in the legs with the boulders, but he was hit in the head as well. He did not lose consciousness. Since the injury he has had headaches and has not been able to walk due to knee pain.
He initially presented to Chedi Clinic, which is our clinic located on the Thai-Myanmar border, about 45 minutes northwest of KRCH.
Dr. Chang Noi (stands for "little elephant") sent him to KRCH after an initial evaluation for head and neck CT as well as bilateral knee xrays. On arrival, imaging was performed. Head and neck CT were negative, which was not surprising given that he had minimal pain and had been doing okay since the injury a week ago.
His lower extremity exam was notable only for tenderness throughout bilateral knees at the joint. There was no swelling or signs of external trauma. He had some pain with range of motion and was not able to bear weight at all due to pain.
Below are his knee xrays (the right is better quality, sorry about that):
His xrays showed bilateral tibial plateau fractures, with some associated joint space narrowing bilaterally. Given his age, his inability to bear weight, and the likely unstable nature of these fractures he was referred for orthopedic evaluation for possible surgery. Because he was unlikely to bear weight at all, we opted not to splint his knees in extension.
Tibial plateau fractures account for only one percent of all fractures. They most commonly involve the lateral plateau and occur after a direct blow to the lateral knee. Xrays will typically reveal a depression of the affected tibial plateau. In more subtle injuries, radiographs may appear normal or show only a slight increase in the density of the bone on an AP view.
Medial tibial plateau fractures require a higher force as this side of the joint has greater strength. A strong medial force or an axial load such as landing on one's feet after falling from a height are potential mechanisms. As you can see in the images, Mr. Yagogo appears to have sustained a left medial tibial plateau fracture, and perhaps the right was also medial, although by the xray it is difficult to tell. When standard radiographs suggest a medial injury, additional imaging often demonstrates simultaneous fractures of both plateaus.
Treatment includes supportive care (compression, icing, appropriate analgesics, elevation) as well as splinting of the knee in near-full extension, and strict non-weight-bearing. The majority of fractures, particularly those sustained from a high energy mechanism, require surgical treatment with open reduction and internal fixation.
Unfortunately our ability to "follow up" on patients here is nearly impossible, so I have no idea how Mr. Yagogo did. My hope is that he made it to the appropriate orthopedic specialist that could manage his fractures surgically, otherwise he may never walk without pain again....
He initially presented to Chedi Clinic, which is our clinic located on the Thai-Myanmar border, about 45 minutes northwest of KRCH.
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| Border crossing in Chedi or "Three Pagoda Pass" |
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| The three pagodas at Three Pagoda Pass |
Dr. Chang Noi (stands for "little elephant") sent him to KRCH after an initial evaluation for head and neck CT as well as bilateral knee xrays. On arrival, imaging was performed. Head and neck CT were negative, which was not surprising given that he had minimal pain and had been doing okay since the injury a week ago.
His lower extremity exam was notable only for tenderness throughout bilateral knees at the joint. There was no swelling or signs of external trauma. He had some pain with range of motion and was not able to bear weight at all due to pain.
Below are his knee xrays (the right is better quality, sorry about that):
His xrays showed bilateral tibial plateau fractures, with some associated joint space narrowing bilaterally. Given his age, his inability to bear weight, and the likely unstable nature of these fractures he was referred for orthopedic evaluation for possible surgery. Because he was unlikely to bear weight at all, we opted not to splint his knees in extension.
Tibial plateau fractures account for only one percent of all fractures. They most commonly involve the lateral plateau and occur after a direct blow to the lateral knee. Xrays will typically reveal a depression of the affected tibial plateau. In more subtle injuries, radiographs may appear normal or show only a slight increase in the density of the bone on an AP view.
Medial tibial plateau fractures require a higher force as this side of the joint has greater strength. A strong medial force or an axial load such as landing on one's feet after falling from a height are potential mechanisms. As you can see in the images, Mr. Yagogo appears to have sustained a left medial tibial plateau fracture, and perhaps the right was also medial, although by the xray it is difficult to tell. When standard radiographs suggest a medial injury, additional imaging often demonstrates simultaneous fractures of both plateaus.
Treatment includes supportive care (compression, icing, appropriate analgesics, elevation) as well as splinting of the knee in near-full extension, and strict non-weight-bearing. The majority of fractures, particularly those sustained from a high energy mechanism, require surgical treatment with open reduction and internal fixation.
Unfortunately our ability to "follow up" on patients here is nearly impossible, so I have no idea how Mr. Yagogo did. My hope is that he made it to the appropriate orthopedic specialist that could manage his fractures surgically, otherwise he may never walk without pain again....
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| Chris and I with our favorite hospital cook Phi Pon. She saves our lives daily with her amazing cooking. |
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