Tibial plateau fractures are periarticular (involve the joint) fractures located in the proximal tibia at the knee. They are often associated with soft tissue injuries of the knee including open fractures, ACL and PCL ruptures, MCL and LCL sprains and meniscal injuries. They may occur and cause compartment syndromes of the leg and possibly vascular compromise both which are limb threatening emergencies.
Tibial plateau fractures are most commonly seen in males. The lateral tibial plateau is most commonly injured. They may be caused by high energy trauma such as an automobile accident where the knee strikes the dashboard or a lower energy mechanism usually a valgus load (knock knee) to the outside of the knee which is common in football.
Tibial plateau fractures may involve a variety of patterns and pieces. The most common descriptions of these fracture patterns is the AO or Shaatzker classification. The classifications allow for more standardized description and treatment for these injuries.
Upon presentation, these fracture are imaged with radiographs and a CT scan to best to visualize fracture patterns and allow for preoperative planning while MRI is most accurate at diagnosing concurrent soft tissue injuries.
Treatment may be operative or nonoperative depending on the fracture pattern and the patient's risks for surgery. These fractures may not be routinely operated on in certain countries depending on the resources available to do so.
Operative treatment may be an external fixator device and or intrafragmentary fixation (ORIF).
Nonoperative treatment would be no weight bearing in a cast or hinged brace followed by early range of motion and progressive weight bearing as fracture healing allows. Immobilization may lead to permanent partial loss of range of motion. Physical therapy may be lengthy in most cases to obtain a normal gait pattern. Operative treatment would be aimed at restoring joint congruency to as close to normal as possible and stabilizing the fracture until it heals.
Long-term complications of this injury may be limb deformity and premature osteoarthritis. In severe cases the patient may require knee replacement surgery.
Shown in the radiographs are an acquaintance of mine is a comminuted bicondylar tibial plateau fracture as a result of a motor vehicle accident. He sustained other serious injuries and was treated in a long leg cast nonweightbearing followed by a hinged knee brace with early motion and P.T.
