What is a tibial plateau fracture?
The tibia (shin bone) is the weight-bearing bone of the lower leg, and its upper portions form two flat surfaces known as the tibial plateaus, that articulate with the femur (thigh bone) to form the knee joint. A tibial plateau fracture is a break or crack in the top of the tibia, at the knee. These types of fractures are typically seen with high-energy trauma in young patients or low-energy falls in the elderly.
Fractures of the tibial plateau are complex injuries, especially since it is one of the most critical load-bearing areas in the human body. This joint helps supports your body weight, and when it is fractured, it is unable to absorb shock. Early detection and appropriate treatment of these fractures are essential in minimizing patient's disability in range of movement, stability and reducing the risk of documented complications
What are the indications for surgery?
The primary aim of surgical management is to restore the articular cartilage surface and ensure proper alignment. Tibial plateau surgery is commonly executed with Open Reduction and Internal Fixation (ORIF). In more complex cases, fractures are sometimes managed with external fixation followed by further ORIF at a later time.
- Minimally displaced tibial plateau fractures:
- Ends of the fracture are displaced < 1 to 2 mm
- Often discovered in patients who injure themselves, have negative x-rays, and later obtain an MRI that reveals the fracture
- Typically treated non-operatively for up to six weeks to ensure the fracture heals in a good position and doesn’t become displaced
- Fractures involving only one tibial plateau:
- If it’s in a critical location or has a significant step-off deformity, treat with surgery to restore the joint surface in almost all circumstances – very important since there is a much higher risk of developing traumatic arthritis if the joint surface is not lined up
- There are multiple classification schemes for these types of fractures, but the most common are involving only one of the tibial plateaus (medial or lateral)
- Fractures involving both tibial plateaus:
- Biggest concern is significant instability and displacement
- Even if there is only minimal displacement, a fracture involving both tibial plateaus may still benefit from surgical fixation
- For severe fractures with multiple pieces, the goal of surgery is to get the joint surface together as best as possible in anticipation of a potential knee replacement once the fracture fragments heal and the arthritis pain becomes more significant
What types of surgery fix tibial plateau fractures?
- Open Reduction and Internal Fixation (ORIF)
- Bone fragments are first repositioned (reduced) into their normal position. They are held together with special devices, such as an intramedullary rod or plates and screws.
- If the fracture doesn’t enter the joint – a rod or plate may be used
- If the fracture enters the joint – Plates and screws are commonly used
- External fixation
- In some cases, the condition of the soft tissue is so poor that the use of a plate or rod might threaten it further. An external fixator may be considered as final treatment
- The external fixator is removed when the injury has healed.