Tibial Plateau Fractures

Question 1

What are associated injuries with tibial plateau fractures?

Answer 1

1) Lateral meniscal tears (peripheral); more common than medial, a/w Schatzker II
2) Medial meniscus tears; most common with Schatzker IV
3) ACL tears; more common in Schatzker V and VI (25%)

Question 2

In an uninjured proximal tibia which statement best describes the shape and position of the medial tibial plateau relative to the lateral tibial plateau?

Answer 2

More concave and more distal

Question 3

What is the classification for tibial plateau fractures?

Answer 3

I- lateral split fx
II- lateral split depression
III- lateral depression
IV- medial condyle fx
V- bicondylar fx
VI- metaphyseal diaphyseal dissociation

Question 4

What are the indications for ORIF of tibial plateau fractures?

Answer 4

1) articular stepoff > 3mm
2) condylar widening > 5mm
3) varus/valgus instability
4) all medial plateau fxs
5) all bicondylar fxs

Question 5

What is the strongest predictor of long term outcomes in tibial plateau fractures?

Answer 5

Restoration of joint stability

Question 6

The posteromedial incision for ORIF of tibial plateau fractures uses what interval?

Answer 6

Between the medial gastroc and semimembranosus

Question 7

When filling a void during ORIF of tibial plateau fracture, what substance has highest compressive strength?

Answer 7

Calcium phosphate

Question 8

What is the post-operative care for ORIF of tibial plateau fractures?

Answer 8

Hinged knee brace, NWB for 8-12 weeks, early RPOM

Question 9

In a Schatzker II tibial plateau fracture, what radiographic measure correlates with a lateral meniscal tear?

Answer 9

Condylar widening of >6mm

Question 10

What variable will most significantly increase the rate of degenerative arthritis in the long-term of ORIF of tibial plateau fractures?

Answer 10

Restoration of mechanical axis

Question 11

What approaches are used for tibial plateau fractures?

Answer 11

1) lateral/anterolateral (1-2cm off tibial crest, extend proximally over Gerdy’s tubercle and LFC)
2) posteromedial (1-2cm posterior to posteromedial tibial border)

Question 12

Where should femoral distraction pins be placed in tibial plateau fractures?

Answer 12

1) Shoulder of LFC
2) Well distal to planned plate position

With a lateral distractor, the limb should be placed initially in relative valgus, as distraction creates a varus bending moment when applied