Tibial Plateau Fracture

Question 1

Which part is most commonly fractured?

Answer 1

Lateral tibial plateau is most frequently fractured.

Often alongside other bony and soft tissue injuries like meniscal tears or cruciate/collateral ligament injury

Question 2

Mechanism of injury

Answer 2

High-energy trauma like fall from a height or RTC.

Impaction of the femoral condyle onto the tibial plateau usually due to a varus-deforming force. This is why the lateral tibial plateau is more frequently fractured.

In elderly it can be due to osteoporosis and subsequently a fall.

Question 3

What is the danger with significant injury of TPF.

Answer 3

Disruption of the congruence of the articular surface can lead to rapid degenerative change within the knee and the joint.

Question 4

Clinical features

Answer 4

History of trauma - Axial loading or high-impact injury increases the likelihood.

Sudden onset of pain

Unable to weight-bear

Swelling of the knee (lipohaemarthrosis)

Question 5

Examination findings

Answer 5

Significant swelling

Tenderness over medial or lateral aspects of the proximal tibia.

Potential ligament instability.

Question 6

What other examination should be done?

Answer 6

Peripheral neurovascular status to assess especially popliteal vessel dissection or common fibular nerve damage.

Question 7

Dx

Answer 7

Knee dislocation

Knee fractures like patella or distal femur

Meniscal injuries

Ligamentous injuries

Patella dislocation or patella/quadriceps tendon rupture

Question 8

Ix

Answer 8

Plain film radiographs (AP + lateral)

CT scanning is needed in almost all cases apart from undisplaced fractures.
Helps assess severity and surgical planning.

Question 9

X-ray findings

Answer 9

Features are often subtly.

There will also be a lipohaemarthrosis present.

Presence of fat in the joint indicates that there is an intra-articular fracture present (tibial plateau, patella, distal femur)

Question 10

What classification is used for TPF

Answer 10

Schatzker Classification

Question 11

Explain Schatzker classification

Answer 11

Type I - Lateral split fracture

Type II - Lateral split - depressed fracture

III - Lateral pure depression fracture (rare)

IV - Medial plateau fracture

V - Bicondylar fracture (rare)

VI - Metaphyseal - diaphyseal disassociation.

Question 12

Indicatiosn for conservative management.

Answer 12

Can be trialled in uncomplicated TPF

No evidence of ligamentous damage, tibial subluxation or articular step <2mm.

Question 13

Conservative management

Answer 13

Hinged knee brace and non- or partial-weight bearing for around 8-12 weeks.

This is alongside physiotherapy and suitable analgesi.

Question 14

Indications of surgical management

Answer 14

Complicated tibial plateau fractures

Open fracture

Compartment syndrome

Medial tibial plateau fracture even if undisplaced.

Question 15

What is a complicated TPF?

Answer 15

Articular step 2mm or more

Angular deformity 10degrees or more

Metaphyseal-diaphyseal translation

Ligamentous injury requiring repair

Associated tibial fractures

Question 16

Surgical intervention

Answer 16

ORIF is mainstay with aim to restory joint surface congruence and ensure joint stability.

Metaphyseal graps can be filled with bone graft or bone substitute.

Question 17

Post-op management

Answer 17

Hinged knee brace with early passive range of movement

Limited or non-weight bearing for around 8-12 weeks

Question 18

When is external fixation indicated?

Answer 18

With delay to any ORIF especially in significant soft tissue injury or in polytrauma/highly comminuted fractures.

Question 19

Complications

Answer 19

Post-traumatic OA