Tibial Plateau Fracture

Question 1

What is the difference between med and lat plateaus?

Answer 1

• medial is larger and concave in sagittal and coronal planes
• lateral is higher and convex in sagittal and coronal planes

Question 2

Describe normal angle

Answer 2

• 10 deg postinf slope

Question 3

What separates the med and lat plateaus?

Answer 3

• intercondylar eminence

Question 4

What is located 2-3cm distal to the tib plateau?

Answer 4

• three bony prominences

Question 5

Describe the three bony prominences?

Answer 5

• ant: tibial tub, pat. tendon attachment
• med: pes anserine, med HS attachment
• lat: Gerdy’s tubercle, ITB attachment

Question 6

MOI of med tib plateau fx

Answer 6

• higher energy

- a/w soft tissue injuries: LCL disruptions, peroneal n. lesions, pop. vessel damage

Question 7

General MOI of tib plateau fx

Answer 7

• valgus/varus w/ axial loading

Question 8

Evaluation

Answer 8

• neuro: ESSENTIAL; trifurcation of pop a. tethered post b/t add hiatus and soleus complex AND peroneal n. tethered lat around fib neck
• aspiration: hemarthrosis
• r/o compartment syndrome
• ligamentous injuries

Question 9

Classification

Answer 9

• Schatzker

Question 10

Schatzker Type I

Answer 10

• lat plateau, split fx

Question 11

Schatzker Type II

Answer 11

• lat plateau, split depression fx (MC)

Question 12

Schatzker Type III

Answer 12

• lat plateau, depression fx

Question 13

Schatzker Type IV

Answer 13

• med plateau fx

Question 14

Schatzker Type V

Answer 14

• bicondylar plateau fx

Question 15

Schatzker Type VI

Answer 15

• plateau fx w/ separation of metaphysis from diaphysis

Question 16

Non-op tx

Answer 16

• nondisplaced or min displaced in pts w/ adv osteoporosis
• NWB, ROM, and hinged knee brace
• quad strengthening
• PWB @8-12w, progress to FWB

Question 17

Surgical indications

Answer 17

• depression >1cm
• instability w/ valgus/varus
• split or open fx
• a/w compartment syndrome
• a/w vascular injury

Question 18

Goal of operative tx

Answer 18

• reconstruction of articular surface, followed by reestablishment of tibial alignment

Question 19

Postop care

Answer 19

• NWB w/ or w/o CPM
• AROM
• WB @ 8-12w

Question 20

Complications

Answer 20

• arthrofibrosis
• infx
• compartment syndrome
• malunion or nonunion
• posttraumatic OA
• peroneal n. injury
• popliteal a. injury
• AVN of small articular fragments