Tibial plateau fracture

Question 1

how does the tibial plateau typically fracture??

Answer 1

high energy trauma (falling from a height / road traffic accident

Question 2

what structures are typically affected?

Answer 2

lateral tibial plateau –> varus-deforming fracture

other bone/ soft tissue injuries e.g. meniscal or ligament damage

Question 3

why is this a significant injury??

Answer 3

disruption of the articular surface –> rapid degenerative changes in the knees

Question 4

what are the clinical features of a tibial plateau fracture?

Answer 4

Hx of trauma (high axial loading/high-impact injury)
sudden onset pain
unable to weight bear
significant swelling
tenderness over medial/lateral aspect of proximal tibia

peripheral neurovascular status may be affected - popliteal vessel disection/common fibular nerve damage

Question 5

what relevant investigations are performed?

Answer 5

X-ray AP and lateral

CT in displaced fracture –> assess of severity and surgical planning

Question 6

what does the presence of fat in the knee joint indicate?

Answer 6

indicates intra-articular fracture (tibial plateau/patella/distal femur)

Question 7

what classification id used in tibial plateau fractures?

Answer 7

the Schatzker classification:
type I: lateral split fracture
type II: lateral split-depressed fracture
type III: lateral pure depression fracture
type IV: medial plateau fracture
type V: bicondylar fracture
type VI metaphyseal - diaphyseal dissasiation

https://www.bing.com/images/search?view=detailV2&ccid=X8GzJcK8&id=D7B72D71AB44BF7D5CDE972AD2EA4B2AE14DF2C3&thid=OIP.X8GzJcK8n85pFP0djhyWbwHaFj&mediaurl=https%3a%2f%2fimage.slidesharecdn.com%2fmanagementoftibialplateaufracture-160205071513%2f95%2fmanagement-of-tibial-plateau-fracture-11-638.jpg%3fcb%3d1454656559&exph=479&expw=638&q=schatzker+classification&simid=608045997076316234&selectedIndex=2

Question 8

what are the management options for tibial plateau fractures?

Answer 8

conservative:
if uncomplicated: no ligament damage, tibial subluxation or articular step <2mm
hinged knee brace 8-12 weeks with ongoing physio and analgesia (non/partial weight bearing)

operative management :
warranted in complicated fractures/ open fracture/ compartment syndrome/ medial plateau fracture

open reduction and internal fixation (ORIF) - restores joint surface congruence and ensures joint instability. metaphysical gaps are filled with graft/ bone substitution

may do external fixation if ORIF cannot be performed

Question 9

what constitutes a complicated tibial plateau fracture?

Answer 9

articular step >2mm 
angular deformity >10 degrees
any metaphyseal-diaphyseal translation 
ligamentous injury 
associated tibial fractures