These injuries may be managed nonoperatively only if there is absolutely no displacement, depression of the tibial plateau, comminution, or associated ligamentous or. Preferred treatment for tibial plateau fractures is open reduction and internal fixation in all displaced and unstable tibial plateau fractures 5,6. A tibial plateau fracture is a break of the larger lower leg bone below the knee that breaks into the knee joint itself. Treatment of highenergy tibial plateau fractures pdf. A tibial plateau fracture is a break of the upper part of the tibia shinbone that involves the knee joint. Tibial plateau fractures are serious articular fractures that are challenging to treat. Fracture reduction can be a challenge to experienced hands and the soft tissue conditions are intolerant of careless dissection. The selection of a surgical approach for the treatment of tibia plateau fractures is an important decision. A new posterolateral approach without fibula osteotomy for.
Tibial plateau fracture symptoms, causes, treatment. Symptoms include pain, swelling, and a decreased ability to move the knee. Type iiia fracture in a 31yearold woman who was in a motor vehicle accident. The conservative treatment of fractures of the lateral tibial plateau has in our experience produced an excellent functional result. The optimal treatment protocol for bicondylar plateau fractures remains controversial. Rg volume 29 number 2 markhardt et al 589 figure 5. Some authors have proposed a posterior surgical approach for this fracture 1, 2. Pdf a study of conservative management of tibial plateau. Tibial plateau fracture phase i maximum protection 0 to 1 weeks. In situations where the bone or cartilage is not well aligned, surgical treatment is more often considered. A prospective study of twentysix cases with twenty month mean follow up. These aims are difficult to reach through a lateral or. Overview of a tibial plateau fracture verywell health. Tibial plateau fracture, bicondylar, hyperextention, anterior midline incision background hyperextension bicondylar tibial plateau fractures are a particular form of tibial plateau fracture with a low incidence 1.
Tibial plateau fracture radiology reference article. Tibial plateau fractures are usually classified with the sixtype schatzker fracture classification. Rehabilitation guidelines for tibial plateau fracture 4 p a g e cardiovascular exercises treadmill running, bike, ube progression criteria independent with hep passing score on return to sport test with low risk of reinjury reported return to sport references. Is early definitive fixation of bicondylar tibial plateau fractures safe. Displaced posterolateral tibia plateau fractures require anatomic articular reduction and buttress plate fixation on the posterior aspect. A series of consecutive patients with bicondylar tibial plateau fractures treated by open reduction and internal fixation with a double buttress. The prognosis of this injury spectrum is largely dependent on the management of each particular configuration, and the literature is as a result littered with a number of management strategies with limited consensus.
Twisting motions and motor vehicle accidents can also cause a tibial. However, broadly speaking fractures of the tibial plateau can b e. Physiotherapy and recovery for fractured tibial plateau or. The role of ct and mri in the assessment of tibial plateau fractures. If the skin is damaged due to the broken bones and there is an open wound, there is a risk of infection for the underlying fracture. Tibial plateau lecture orthopaedic trauma association ota. Nondisplaced fractures of the tibial plateau can often be treated nonoperatively with a period of nonweight bearing with a hinged knee brace. They are frequently unstable with knee flexion even in the absence of an axial load.
Tibial plateau fractures were originally termed a bumper or fender fracture but only 25% of tibial plateau fractures result from impact with automobile bumpers. Treatment of highenergy fractures of the tibial plateau requires an inordinate degree of surgical effort in order to avoid complications. The treatment of tibial plateau fractures in elderly patients is challenging, and the comprehension of epidemiology and morphology can be helpful. Tibial plateau fractures are the most common intraarticular fractures, which require careful evaluation and preoperative planning. Treatment of posterior tibial plateau fractures via. Posterior tibial plateau fractures are not uncommon injuries and often necessitate surgical treatment. Tibial plateau fractures have always been a challenge for orthopaedic surgeons. Tibial plateau fractures most commonly require orthopedic consultation. Contrary to popular practice which favors a staged protocol in. Axially unstable tibial plateau fracture bicondylar fracture schatzker type v and vi fracture dislocation. Treatment of complicated tibial plateau fractures with dual plating. Tibial plateau fractures are complex injuries of the knee.
Surgical treatment of posterior tibial plateau fractures. Tibial plateau fractures can occur as a result of highenergy trauma or in lowenergy trauma when bone quality is poor. A tibial plateau fracture is a break to the upper surface of the tibia shin bone. Rehabilitation guidelines for tibial plateau fracture 2 p a g e phase ii weeks 612 dates. All highenergy tibial plateau fractures must be immediately checked for softtissue integrity. Isolated medial plate fixation for a medial tibial plateau fracture. However, despite the spectrum of possible fracture patterns, the treatment principles remain the same with the aim of restoring the congruity of the articular surface.
The most common mechanism of injury is motor vehicle accident, followed by falls and sports injuries, with 40% of injuries being polytrauma. But one should remember that any type of tibial plateau fracture can present with softtissue complications. Tibial plateau fractures should be considered as complex injuries representing a wide fracture spectrum. The surgeon must determine whether adequate fixation can. Tibial plateau fractures orthopaedic trauma association. Arthroscopically assisted fixation of the tibial plateau fractures. This approach is ideal for fractures of the posterior aspect of the tibial plateau, as it allows for direct open reduction and buttress plate fixation. Tibial plateau fractures can occur as a result of highenergy trauma or in low energy trauma when bone quality.
Spence reid, md, penn state bone and joint institute explains, this fracture pattern may occur as part of a fracture dislocation in which it is often associated with an acl tear, or as part of a bicondylar tibial plateau fracture. Regular manual treatment should be conducted to the patella and all incisionswith particular attention to the anterior medial portalto decrease the incidence of fibrosis. In general, tibial plateau fractures are to be operated on, but the decision whether to operate or not on a specific fracture should be based on the fracture morphology, the soft tissues and the patients general condition, and the expected limb axis and articular surface restoration. Appointments md follow up at week 6 continue physical therapy 2 x week rehabilitation goals regain full knee rom normalize gait out of brace strengthening of les and core. Tibial plateau fracture causes, symptoms and treatment. Tibial plateau fracture treatment nonsurgical management.
Schatzker classification system is one method of classifying tibial plateau fractures increase in type number denotes increasing severity, reflecting an increase in energy imparted to the bone at the time of injury and also an increasingly worse prognosis 1. The mean age of people with this type of fracture is 50. The treatment for tibial plateau fractures aims to achieve anatomical reduction of the joint surface and stable osteosynthesis in order to enable early mobilization, so as to prevent complications such as joint stiffness and general postoperative complications such as deep vein thrombosis or pulmonary embolism. Tibial plateau fractures form a wide spectrum of injuries presenting varying challenges to the trauma surgeon. Tibial plateau fracture sports injuries, treatment and. Early detection and appropriate treatment of these fractures are essential in minimizing patients disability in range of movement, stability and reducing the risk of documented complications. Early detection and appropriate treatment of these fractures are critical for minimizing patient disability and reducing the risk of documented complications, particularly posttraumatic ar. This study described the characteristics of geriatric tibial plateau fractures. These fractures may require surgical treatment to cleanse the fracture surfaces and soft tissues to lessen the risk. Tibial plateau fractures are serious injuries, and are common in highimpact sports like football, rugby and basketball. As with other tibial plateau fractures, knee instability and articular incongruity are indications for surgery. Although this is a schatzker vi type tibial plateau fracture, it has distinct injury mechanisms, frac. Learn signs of the fracture and surgical and nonsurgical treatment plans. The most common mechanism of injury involves axial loading, e.
You will be unable to weight bear and may complain of. Posterior fractures on the medial side are mainly highly instable fracture dislocations moore type i. In surgical terms there are 6 different classifications of tibial plateau fractures, dependi ng on the severity and the nature of the injury. Tibial plateau fractures initial management guidelines. Fracture course tibial plateau fractures objectives identify and classify the fractures treatment algorithm why, how, when to treat understand predictors of treatment success failure classification primarily low energy fractures schatzker i solitary lateral condyle fracture line lateral articular surface depression. When the diagnosis of type iii tibial plateau fracture is made and confirmed during arthroscopy, an additional working portal should be created to achieve proper access to the posterolateral tibial plateau. Treatment of the posterolateral tibial plateau fractures. Pdf tibial plateau fractures are complex injuries produced by high or low energy trauma. Mediumterm results after surgical treatment of highenergy tibial plateau fractures. Fracture dislocation injuries of the knee can be distinguished from tibial plateau fractures 24, but certain plateau fracture patterns, namely posterior, posteromedial, and medial plateau sheartype fractures, may represent a transient dislocation event and warrant appropriate workup including neurologic and vascular assessments.
Allarthroscopic treatment of schatzker type iii lateral. The aim of treatment for fractured tibial plateau or tibial plateau fractures is achieving painless, aligned, stable and mobile joint and minimisation of posttraumatic osteoarthritis risks. Allarthroscopic treatment of type iii tibial plateau fracture without using fluoroscopy. Approximately 90% of all tibial plateau fractures have some sort of soft tissue injury and % are open fractures. Anywhere from 5570% of tibial plateau fractures are isolated lateral plateau fractures, 1025% involve only the medial plateau, and 1030% are bicondylar fractures. Surgical exposure of these fractures from anterior requires major. Posterolateral fractures usually cause massive depression and destruction of the chondral surface. Treatment of a tibia fracture depends on several factors, including a persons overall health at the time of the injury, the cause and severity of the injury, and the presence or extent of.
Arthroscopic management of tibial plateau fractures em consulte. In this type of fracture, the tibial plateau or the tibia is fractured without any bone fragment separation. Anatomy the tibia is a triangularly shaped bone in cross section that flares from the relatively narrow diaphysis to the proximal tibia. Treatment of tibial plateau fractures that involve the medial condyle can be challenging. Complication may include injury to the artery or nerve, arthritis, and compartment syndrome. Tibial plateau fracture brigham and womens hospital. Pdf treatment strategy for tibial plateau fractures.
These findings are suggestive of a depressed fracture of the lateral tibial plateau, a schatzker type. To establish a classification system for the different types of posterior tibial plateau fractures. Approximately 7% of all tibia plateau fractures affect the posterolateral corner. Identify common fracture patterns apply treatment principles and strategies partial articular fractures complete articular fractures discuss rehabilitation, complications, and outcomes illustrate selected tibial plateau cases. Thus, to be successful, treatment of a tibial plateau fracture must ensure that the joint remains stable, that the articular surfaces remain con gruous. Tibial plateau fractures with depression of posterior aspects of the proximal tibia cause significant therapeutic problems. The aim of physiotherapy after a fractured tibial plateau or tibial plateau fractures is to help you heal soon.
Objectives recognize the anatomy of the proximal tibia. In patients without displacement of the fracture or the cartilage, there is a role for nonsurgical management. Treatment of tibial plateau fractures depends most importantly on how well aligned the knee joint cartilage is. A tibial plateau fracture generally results from trauma to the upper part of your shin. Any information contained in this pdf file is automatically generated from. Tibial plateau fracture causes, types, symptoms, diagnosis. Risk of total knee arthroplasty after operatively treated tibial plateau fracture. Mikkelsen 1 has classified 18 types of fracture involving the proximal articular surface of the tibia. The full text of this article is available in pdf format. Nonoperative and operative treatment plans are considered by doctors to achieve this. The cause is typically trauma such as a fall or motor vehicle collision. Classification useful for 1 true fracture dislocations 2 fracture patterns that do not fit into the schatzker classification 10% of all tibial plateau fractures 3 fractures associated with knee instability. Non displaced fractured tibial plateau or non displaced tibial plateau fractures have a better prognosis than displaced fractures and often heal within 34 months without any surgical intervention, but the patient should not bear weight. However, three types of fractures generally occur in the lateral plateau.
The tibial plateau is prone to becoming fractured in highspeed accidents such as those associated with skiing, horse riding, and certain water sports. The schatzker classification system for tibial plateau fractures is widely used by. Diagnosis and treatment of hyperextension bicondylar. When prophylaxis is chosen, although we have a preference for lmw heparin, the optimal. Use of an injectable calcium phosphate bone cement in the treatment of tibial plateau fractures. This is an injury that can involve the bone, meniscus, ligaments, muscles, tendons and skin around the knee. Fractures of the posteromedial tibial plateau are challenging to treat, owing to their complexity and unfamiliar surgical approach. Once the tibial plateau fracture has been diagnosed a number of treatment options are available depending on the extent of the damage. New developments in treatments of tibial plateau fractures. A tibial plateau fracture involving posterolateral fragments is an uncommon injury that is rarely reported in the literature. Tibial plateau fractures musculoskeletal medicine for. Schatzker classification of tibial plateau fractures.
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