What is the tibial plateau?
The tibia (shin bone) is the weight-bearing bone of the lower leg. The upper part of the tibia is widened by the medial and lateral condyles, which aid in weight-bearing. These condyles form a flat surface, known as the tibial plateaus, that articulate with the femur (thigh bone) to form the knee joint.
What is a tibial plateau fracture?
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 symptoms?
- Pain or discomfort in or around the upper part of your shin from impact
- Pain and difficulty bearing weight on your leg
- Bruising and swelling
- Limited range of motion
How is a tibial plateau fracture diagnosed?
Tibial plateau fractures have a wide range of presentations – from very small fractures only seen on MRI scans, to significant injuries with several bone pieces that are nearly impossible to put back together. While those with fractures that only show up on MRI scan have an excellent outcome and a fairly quick return to activities, those involving significant disruption with multiple pieces of the lateral tibial plateau often have a poor prognosis.
X-rays are always the first line when assessing fractures, but MRI has been shown to classify and assist the management of tibial plateau fractures better than any other imaging study.
What is the treatment of tibial plateau fractures?
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
Development of osteoarthritis following tibial plateau fracture is common (approximately one-third of all tibial plateau fractures) due to the articular surface being involved, despite the age of the patient at the time of fracture