Tibial Plateau Fracture: Classification, Diagnosis and Treatment
Tibial plateau fractures involve the upper end of the tibia bone that carries the weight of the body across it.
This part of the tibia bone has important ligaments attached to it that help in maintaining the stability of the knee joint. So any fracture in the upper end of the tibia can have a profound effect on the functioning of the knee joint. Before going further lets know about the anatomy of the upper part of the tibia bone.
The upper part of the tibia bone is expanded like a cone with the base of the cone located upwards and the tip pointing to the foot.
This can be divided into two parts. One inner part and one outer part. The outer part is called the lateral condyle and the inner part is called the medial condyle. Posteriorly or behind, the condyles extend out like a platform. The upper surface is covered with cartilage and articulates with the corresponding part of the femur.
In the center some part is devoid of cartilage and this is where important ligaments attach. In the front there is a slight projection that provides attachment to the patellar tendon.
You can see more at the knee anatomy page.
Usual way of sustaining a tibial plateau fracture is by a road traffic accident. A bumper of the vehicle hitting the pedestrian on the leg. Other ways in which this fractured can be sustained include a fall from height, domestic and industrial accidents and during sports. These fractures can also occur as a result of osteoporosis.
Usual symptoms after sustaining the fracture include
- difficulty or inability to walk or move the limb
- bruising may be seen over the skin
Sometimes in low energy fractures the symptoms may be mild and the patient may be able to walk with difficulty. In such patients the fracture can be missed and a diagnosis of sprain may be made. So it is best to have a x ray unless one is absolutely certain.
During examination it is important to see for the pulse, loss of ankle and toe movement and loss of sensation. This helps to rule out the injury to blood vessels and nerves.
Ligaments may be torn, but at the time of acute injury it is difficult to clinically assess the integrity of the ligaments due to the pain, swelling and bony instability.
Schatzker classification of tibial plateau fracture is given below. It is the most commonly used classification for this fracture.
- Type 1 is a split fracture involving the lateral condyle
- Type 2 is a split fracture of the lateral condyle along with depression of the bone
- Type 3 is a depression fracture of the lateral condyle
- Type 4 is a fracture of the medial condyle
- Type 5 is a fracture involving both the condyles
- Type 6 is a fracture of both the condyles that extends downwards to the shaft of the tibia bone
Type 1 to 4 are usually low energy injuries where as type 5 and 6 are usually high energy injuries. Therefore type 5 and 6 may be associated with lacerations, contusions and bruises to the skin. Compartment syndrome, ligament injuries and injuries to the nerves and blood vessels may also be present.
Diagnosis of tibial plateau fracture is made by x ray examination of the knee joint in two planes perpendicular to each other. At times x rays in a diagonal plane may be done if the fracture is not clear on the routine views. CT and MRI scans may also be required to have a clear assessment of the fracture pattern and to find out injuries to the ligaments.
Aim of treatment is to provide a stable, congruent and smooth joint surface of the upper end of tibia so that there is complete recovery of the knee joint function.
Treatment of tibial plateau fracture depends on the classification and the degree of displacement of the fracture. Displacement or depression of the fracture fragment up to 5mm can be treated by non-operative methods. If the depression or displacement is greater than 5 mm then surgery is indicated.
Methods of non-operative treatment for tibial plateau fracture include the following
- plaster cast immobilization
- skeletal traction
- functional cast bracing
Methods of operative treatment include the following
- Internal stabilization of the fracture with screws alone or with a combination of plate and screws
- External stabilization with a fixator frame applied around the limb
Method of treatment to be used is decided by the following factors
- Classification of the fracture
- Displacement of the fracture fragments
- Condition of the skin, subcutaneous tissue and muscles
All undisplaced fractures from type 1 to 4 can be treated by non-operative methods.
- Type 1 displaced fractures are surgically stabilized with screws alone or with a plate and screws.
- Type 2 displaced fractures are surgically stabilized with screws alone or with a plate and screws after elevating the depressed bone fragment.
- Type 3 depressed fractures are surgically stabilized with screws after elevating the depressed bone fragment.
- Type 4 displaced fractures are surgically stabilized with screws alone or with a plate and screws.
- Type 5 and 6 displaced fractures are surgically stabilized with screws and one or two plates if the skin condition is normal and with a external fixator frame if the skin is lacerated, contused or bruised.
Complications of tibial plateau fracture include the following
- Loss of knee movement
- Irritation of skin from plates and screws
- Late collapse of the fracture
- Arthritis of the knee joint
Frequently Asked Questions
How long does the fracture take to heal?
The fracture takes 12 to 18 weeks to heal completely
How can loss of knee movement be prevented?
Loss of knee movement can be prevented by early mobilization of the knee joint after the surgery. For this surgical stabilization should be strong enough to allow movement of the knee joint without displacement of the fracture fragments.
How long does it take to reach the activity and strength level as before the fracture?
Muscles atrophy after any fracture. These weak muscles can make moving around painful and slow. To strengthen them, intensive physiotherapy is required.
With out physiotherapy it can take 8 to 10 months to reach the the pre-fracture level of muscle power and agility.
If you want to return quickly to the pre fracture level of activity following a tibial plateau fracture you need to do intensive physiotherapy at home or at a physiotherapy centre.
How can late collapse be prevented?
Late collapse of the fracture usually occurs if the patient starts walking before the fracture has healed adequately. This can be prevented by starting to walk only after complete healing of the fracture.
How can arthritis be prevented?
Arthritis is a late complication of this fracture that usually occurs after a few years. If can be prevented by accurate re-alignment of the fracture fragments as close to normal as possible. Nothing less than perfect should be accepted, but this is not always possible to achieve.
I hope the information provided was helpful. If you have any query you can ask me at the contact me page.
This page was updated on 25th January 2011.
Other fractures of the knee joint...
Other causes of knee pain include...
Osgood Schlatter Disease
Knee Replacement Surgery
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