A tibial plateau fracture affects the stability of the knee joint. Proper evaluation and treatment are crucial for restoring a patient's function and range of motion.
The tibia (or shin) is one of two lower leg bones. Its upper surface is called the tibial plateau. This surface sits below the lower surface of the femur. These two bones, along with the patella (knee cap) are the bones of the knee joint.
Several ligaments and tendons hold this complex joint together in a stable position. The knee joint is critical because it is a major weight-bearing joint and as such, a tibial plateau fracture must be properly evaluated and treated in a timely manner to optimize the patient's function and range of motion.
Injuries to this structure are of two general types: low-energy or high-energy. A low-energy injury is often a result of a fall by an elderly patient with poor bone quality. It can also be found in some sports injuries in the young. A high-energy injury is typically caused by a motor vehicle accident or some very high velocity sports injuries.
The fracture itself is classified by any of several methods, the most common being the Schatzker classification system. This system is based on the location of the fracture and the severity of the injury and of any associated bone depression. Treatment will be guided in part by the classification of the injury but must also include a careful evaluation of damage to any soft tissues or nearby neurovascular structures.
A thorough evaluation will include a physical exam and one or more radiology tests. X-rays will certainly be ordered but may miss, or inadequately show, more subtle injuries. For this reason, CT scans are often used as well. The classification of the injury, and thus its treatment, is often changed as a result of a CT scan. An MRI is used less often, but may be useful, especially to evaluate the nature and extent of soft tissue damage, particularly the ligaments, cartilage and menisci of the knee joint.
Non-surgical treatment is possible if the fracture has not resulted in any bones, or portion of bones, becoming displaced or out of position. In this case, treatment will consist of the fracture being immobilized using a bracing system. It is important that the patient does not allow any weight to be put on the joint. Physical therapy will be needed so that the leg muscles remain strong during recovery. It is possible for a fracture to become displaced during recovery and if this happens, surgery may still be required.
Surgery will likely be required to treat a tibial plateau injury in which the bone has broken into fragments which became displaced from their proper position. The purpose of the surgery is to reposition and align the fragments and then fix them in this position. There are many methods of fixation, both internal and external. Internal fixation may include placing screws into the fractured bones. If additional stability is required, plates can be screwed into place on the bone. Bone grafts or bone cement may also be used to repair the fracture or to fill a depression on the bone's surface.
Surgery is also indicated when there is injury to the soft tissues of the joint in addition to any displacement of the bone. If the soft-tissue damage is severe, the choice of fixation method becomes complicated. There may be either internal or external fixation, or a combination of both. Arthroscopy may be useful in determining both the extent of the soft tissue damage and in determining the best surgical treatment.
The recovery time for a tibial plateau fracture will take several months. Often the brace used to immobilize the knee will allow some movement. This is permitted but it is critial to recovery that the joint is not permitted to bear any weight. Physical therapy to keep the undamaged leg muscles strong is important because of the length of the recovery time, which can be quite long if there is significant damage to either the bone or the soft tissues of the joint.