Case Report of a Tibial Plateau Fracture Extending Through the Tibial Diaphysis after Low Energy Injury in a Patient with Rheumatoid Arthritis

Introduction: The combination of tibia plateau and shaft fractures, previously reported as type of “bifocal” tibia fracture, is a rare injury.1 The majority of tibia plateau fractures and bifocal tibia fractures occur after high-energy trauma.1,2 The treatment of these injuries varies depending on type, mechanism of injury, and patient characteristics. Case Presentation: We report the case of one patient who sustained a Schatzker VI tibial plateau fracture with extension through the tibial diaphysis after a low-energy injury, likely due to her history of Rheumatoid Arthritis (RA) treated with Methotrexate (MTX) and Prednisone. The patient was initially managed with external fixation to allow for soft tissue resuscitation followed by open reduction and internal fixation. The fracture went on to fully unite. Conclusion: Bifocal tibia fractures are a challenging entity. There is sparse literature regarding the treatment of this type of injury. We have found only one review of bifocal tibia fractures and one paper reporting on the treatment of noncontiguous ipsilateral tibia plateau and shaft fractures. To our knowledge, no prior case reports have been published regarding this injury. Central Bringing Excellence in Open Access   Podolnick et al. (2015) Email: Ann Orthop Rheumatol 3(4): 1057 (2015) 2/5 of injury. We will discuss the probable cause of the injury as well as our treatment algorithm.