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Tibia Plateau Fractures

Categories
  • Joint/Tendon
  • Knee
Tags
  • knee injury
Knee Anatomy & Examination

Tibia Plateau Fractures

Tibia plateau fractures

The proximal part of the tibia consists of the medial and lateral tibia plateaus and the tibia spines where the anterior and posterior cruciate ligaments attach.

Coronal view of left knee
Coronal view of left knee
Sagittal view of left knee
Sagittal view of left knee
Injury mechanism:
  • Axial compression to the tibia plateau due to motor vehicle accidents or falling from a height.
  • There is usually a valgus or varus moment with indirect shear forces.
Associated injuries:
  • Meniscus tears.
  • Cruciate or collateral ligament tears.
  • Soft tissue injury: appropriately manage the associated soft tissue injury to reduce risk of complications.
  • Risk of compartment syndrome. Assess for this and always monitor neurovascular status.

Presentation

  • Pain to the knee area
  • Pain may be aggravated with weight bearing
  • Soft tissues swelling around knee area

Associated Common Peroneal nerve injury

Associated Common Peroneal nerve injury
Foot/ankle ROM
Common Peroneal nerve responsible for ankle dorsiflexion

Associated meniscus tears

Meniscus tear patterns
Examples of meniscus tear patterns

Associated Knee ligament tears

Associated Knee ligament tears
Examples of ligament tears around the knee joint

Tibia plateau fracture Schatzker classification

Tibia plateau fracture Schatzker classification
  • Type Ⅰ: Lateral plateau split
  • Type Ⅱ: Lateral plateau split-depression
  • Type Ⅲ: Lateral plateau depression
  • Type Ⅳ: Medial plateau split
  • Type Ⅴ: Medial and lateral plateau split
  • Type Ⅵ: lateral plateau and metaphyseal-diaphyseal fractures

Tibia plateau fracture Moore classification

Tibia plateau fracture Moore classification
  • Type A: Medial plateau split in coronal plane
  • Type B: Medial plateau split
  • Type C: Rim avulsion
  • Type D: Depression
  • Type E: Four part fracture

OTA/AO Tibia plateau classification

OTA/AO Tibia plateau classification

Management

  • Undisplaced stable fractures can be managed non-operatively with brace/cast
  • Displaced fractures require open reduction and internal fixation (ORIF) with screws, plate/screws ⨥ bone graft or ring external fixator, depending on the fracture configuration
  • Bicondylar fractures can be managed with a locked single condylar plate or alternatively with bilateral condylar plates
  • Knee arthroscopy can be used as an adjuvant modality to address fracture ORIF

Surgery Options

Screw fixation in select stable
Screw fixation in select stable, minimally displaced fractures
Plate and screw fixation
Plate and screw fixation
Bone graft with ORIF plate and screw fixation
Bone graft with ORIF plate and screw fixation

Rehabilitation

Knee ROM brace

Knee range of motion (ROM) brace allows the degree of knee ROM to be set

Foot/ankle ROM

Foot ROM with brace on, pre and/or post-surgery allowing lower limb circulation

Download ASSIC Performance Fingerprint or Strength & Conditioning apps to create or download guideline (pre and post surgery) rehab routines

apple app store  google play store

References

  1. Revisiting the Schatzker classification of tibial plateau fractures. Mauricio Kfuri, Joseph Schatzker. Injury. 2018 Dec;49(12): 2252-2263.
  2. Factors influencing the functional outcomes of tibia plateau fractures after surgical fixation. B Polat, T Gurpinar, A E Polat, Y Ozturkmen. Niger J Clin Pract. 2019 Dec;22(12):1715-1721.
  3. Tibia plateau fracture mapping and its influence on fracture fixation. Lorcan McGonagle, Tim Cordier, Bjorn C. Link, Mark S. Rickman and Lucian B. Solomon. J Orthop Traumatol 2019 Dec; 20:12.

Contributor:

Dr M Y Hassan

Learn More

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