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.
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Tibia Plateau Fractures
Tibia Plateau Fractures
Tibia plateau fractures
Coronal 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
Common Peroneal nerve responsible for ankle dorsiflexion
Associated meniscus tears
Examples of meniscus tear patterns
Associated Knee ligament tears
Examples of ligament tears around the knee joint
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
- 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
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, minimally displaced fractures
Plate and screw fixation
Bone graft with ORIF plate and screw fixation
Rehabilitation
Knee range of motion (ROM) brace allows the degree of knee ROM to be set
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
References
- Revisiting the Schatzker classification of tibial plateau fractures. Mauricio Kfuri, Joseph Schatzker. Injury. 2018 Dec;49(12): 2252-2263.
- 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.
- 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.
