This paper defines fracture-dislocation of the knee as a distinct injury, separate from both tibial plateau fracture and classic knee dislocation. Moore builds a five-type radiographic classification from 132 cases drawn from over 1,000 proximal tibial fractures. The central question: how do we recognize and manage these unstable injuries with their high rate of occult soft-tissue and neurovascular damage?
When you see a proximal tibial fracture with a fibular styloid avulsion, an avulsed anterior spine, or a rim fragment, stop calling it a plateau fracture. Moore's core teaching is that these patterns carry occult ligament rupture and neurovascular injury that plain plateau fractures do not.
The practical rule: examine under anesthesia with stress films. Nearly two-thirds of Type 3 and Type 4 injuries hide intraligamentous rupture on the opposite side of the knee that you cannot see on the fracture film. Think of the five types as a spectrum of instability and energy, with Type 5 approaching a true dislocation and demanding a vascular exam and low threshold for angiography.
The distinction still matters for boards: plateau fracture displaces the central surface without capsular or ligament injury, while fracture-dislocation is defined by that soft-tissue disruption. Prognosis tracks the same spectrum, worst in Type 5.
This paper defines fracture-dislocation of the knee as a distinct injury, separate from both tibial plateau fracture and classic knee dislocation. Moore builds a five-type radiographic classification from 132 cases drawn from over 1,000 proximal tibial fractures. The central question: how do we recognize and manage these unstable injuries with their high rate of occult soft-tissue and neurovascular damage?
When you see a proximal tibial fracture with a fibular styloid avulsion, an avulsed anterior spine, or a rim fragment, stop calling it a plateau fracture. Moore's core teaching is that these patterns carry occult ligament rupture and neurovascular injury that plain plateau fractures do not.
The practical rule: examine under anesthesia with stress films. Nearly two-thirds of Type 3 and Type 4 injuries hide intraligamentous rupture on the opposite side of the knee that you cannot see on the fracture film. Think of the five types as a spectrum of instability and energy, with Type 5 approaching a true dislocation and demanding a vascular exam and low threshold for angiography.
The distinction still matters for boards: plateau fracture displaces the central surface without capsular or ligament injury, while fracture-dislocation is defined by that soft-tissue disruption. Prognosis tracks the same spectrum, worst in Type 5.