Type iii depression fractures were caused by lowenergy injuries in osteopenic bone. A tibial plateau fracture is a fracture involving the proximal upper portion of the tibia which extends through the articular surface into the knee joint. Apr 20, 2020 the tibial plateau is one of the most critical loadbearing areas in the human body. Monu, schatzker classification of tibial plateau fractures. Between january 2010 and january 2012, 184 tibial plateau fractures were diagnosed and operated on in our institution. Tibial plateau fractures form a wide spectrum of injuries presenting varying challenges to the trauma surgeon. Lipohemarthrosis presence of fat and blood from bone marrow in the joint space after an intraarticular fracture seen on xray in a person with a subtle tibial plateau fracture ap, lateral, oblique views internal for lateral plateau, external for medial plateau. Original article posterior tibial plateau fracture. Tibial plateau fractures musculoskeletal medicine for.
Tibial plateau fractures are commonly described as a combination of fractures affecting medial, lateral or both condyles in the sagittal plane. Among available classifications for tibial plateau fractures 17, the schatzker classification is the most widely used tool. Tibial plateau fractures account for 12% of all adult fractures. Because most tibial plateau fractures involve thelateral tibial plateau, an anterolateral approach is the most frequently used approach for the treatment of plateau fractures figs. Tibial plateau fractures may be either lowenergy or highenergy. Anywhere from 5570% of tibial plateau fractures are isolated lateral plateau fractures, 1025% involve only the medial plateau, and 1030% are bicondylar fractures. A fracture to the tibial plateau alone can be a devastating injury. Many fractures of the tibial plateau can be treated with an anterolateral approach to the proximal tibia. Tibial plateau fractures commonly occur as a result of motor vehicle accidents in younger individuals and as a result of osteoporosis in elderly women.
Tibial plateau fractures occur by three main mechanisms. May 14, 20 the standard approach to lateral tibial plateau fractures involves elevation of the iliotibial band it and anterior tibialis origin in continuity from gerdys tubercle and metaphyseal flare. Posterior tibial plateau fracture ptpf is a spe cial type of plateau fracture. Tibial plateau fractures tpfs are common and difficulttomanage injuries that can be due to high or lowenergy trauma and can affect young adults or thirdage patients. Due to its special location, it is difficult to perform open reduction and internal fixation, which is a difficulty in orthopedics 1. Oct 17, 2017 tibial plateau fractures form a wide spectrum of injuries presenting varying challenges to the trauma surgeon. From january 2004 to december 2008, 230 patients with tibial plateau fractures were operated on at our institution. Tibial plateau fracture could be caused by indirect violence or direct violence. Dec 06, 20 anatomy the tibial plateau is the proximal end of the tibia including the metaphyseal and epiphyseal regions as well as the articular surfaces made up of hyaline cartilage. There are about 6 surgical approaches in tibial plateau of which, most commonly used ones are. Symptoms consist of pain, swelling, along with a decreased capability in order to move the knee. It is usually the result of a low energy injury in young individuals with normal mineralization. The approach entails a partial tenotomy of the anterior half. Early detection and appropriate treatment of these fractures are critical for minimizing patient disability and reducing the risk of documented complications, particularly posttraumatic ar.
All specimens showed similar elliptical loss of cartilage in the anteromedial part of the tibial plateau. Department of orthopaedics, geisinger medical center, danville. This highenergy trauma is frequently associated with meniscal detachment seen in one half of patients and acl avulsions seen in one third of patients. Tibial plateau fractures initial management guidelines. In the past, doctors and patients lacked of sufficient knowledge about posterior tibial plateau fracture due to various causes 2,3. Aug 08, 2018 a tibial plateau fracture is a disruption of the upper portion of the tibia a. Tibial eminence involvement with tibial plateau fracture pre. This is a simple illustration of the anterior view of the human knee showing the normal anatomy which would be suitable for patient education or textbook use, and is used to help orient the viewer to where the view of the superior view of the normal tibial plateau is based in relation to the entire joint. Nov 05, 2016 tibial plateau fractures are, as you now know, significant injuries.
Tibioplasty, a new technique in the management of tibial plateau. The aim of treatment for fractured tibial plateau or tibial plateau fractures is achieving painless, aligned, stable and mobile joint and minimisation of posttraumatic osteoarthritis risks. Tibial plateau fractures orthopaedic trauma association. Type i lateral tibial plateau fracture without depression. The traditional methods in displaced tibial plateau fractures use metallic instrumentation. Pdf populationbased epidemiology of tibial plateau fractures. Tibial plateau fractures with and without meniscus tear. We describe an alternative approach to increase lateral plateau joint exposure and maintain iliotibial band insertion to gerdys tubercle. Tibial plateau fractures objectives identify and classify the fractures treatment algorithm why, how, when to treat understand predictors of treatment success failure classification primarily low energy fractures schatzker i solitary lateral condyle fracture line lateral articular surface depression schatzker i. A total of 4550% patients had a macroscopically normal acl, 2123% had synovial loss. The first types involve only the lateral tibial plateau. The mean bony surface area was measured upon adequate exposure of the proximal tibial cortex. Populationbased epidemiology of tibial plateau fractures article pdf available in orthopedics 389. The patient was then placed in a large jetx external fixator which spans across the knee, using 10.
The prognosis of this injury spectrum is largely dependent on the management of each particular configuration, and the literature is as a result littered with a number of management strategies with limited consensus. Management of tibial plateau fracture linkedin slideshare. Pdf variation in the anatomy of the tibial plateau a. We present our technique for this approach with special focus on performing a submeniscal arthrotomy, placing a femoral distractor and elevation of the joint surface. Tibial plateau fractures are, as you now know, significant injuries. Nonoperative and operative treatment plans are considered by doctors to achieve this. Early detection and appropriate treatment of these fractures are essential in minimizing patients disability in range of movement, stability and reducing the risk of documented complications. Type v, or a split bicondylar fracture, is a fracture of both the lateral and medial tibial plateau, usually with lateral depression. Anterolateral approach for the treatment tibial plateau. Association of position of reduction and inherent lower limb. The standard approach to lateral tibial plateau fractures involves elevation of the iliotibial band it and anterior tibialis origin in continuity from gerdys tubercle and metaphyseal flare. It is a serious type of knee injury that can affect all types of men and women athletes.
No tibial eminence fractures received fixation specifically. The tibial plateau is located at the very top of the tibia, which forms the surface of the joint, together with the condyles knuckles of the femur. When faced with one of these injuries there are some questions to be answered. To establish a classification system for the different types of posterior tibial plateau fractures. Original article surgical options for posterior tibial. Tibial plateau fracture postoperative protocol phase i maximum protection 0 to 1 weeks. The quickest way to delay your return to activity is to try to speed up recovery.
Imaging of knee injuries with special focus on tibial plateau. Tibial plateau fractures that involve the medial condyle, schatzker iv, and bicondylar fractures, schatzker v and vi, can be challenging to treat. Critical care mailbag end tidal co2 in cardiac arrest 6. They are more so in teenagers as your bones are still in various stages of development. Treatment of the posterolateral tibial plateau fractures. Tibial plateau lecture orthopaedic trauma association ota. Tibial plateau fractures objectives identify and classify the fractures treatment algorithm why, how, when to treat understand predictors of treatment success failure classification primarily low energy fractures schatzker i solitary lateral condyle fracture line.
Schatzker classification system is one method of classifying tibial plateau fractures increase in type number denotes increasing severity, reflecting an increase in energy imparted to the bone at the time of injury and also an increasingly worse prognosis 1. Highenergy fractures are often a result of motor vehiclerelated trauma, and the most common pattern of fracture in this group is a splitting fracture. Tibial plateau medical definition merriamwebster medical. Prone and direct posterior approach for management of. Jan 22, 2019 the aim of treatment for fractured tibial plateau or tibial plateau fractures is achieving painless, aligned, stable and mobile joint and minimisation of posttraumatic osteoarthritis risks. Arthroscopic management of tibial plateau fractures carlos. Schatzker classification for tibial plateau fracture. Tibial plateau fractures statpearls ncbi bookshelf.
With appropriate medical guidance, patient rehabilitation is possible. Restore joint congruity preserved normal mechanical axis stable joint restore knee motion 3. This is a wedgeshaped pure cleavage fracture and involves a vertical split of the lateral tibial plateau. Even undisplaced tibial plateau fractures should be operated, so that early mobilization of knee it is possible. The longterm outcome of tibial plateau fractures treated by cast bracing was observed in 29 patients sustaining 30 tibial plateau fractures more than ten years after injury. A tibial plateau fracture is a disruption of the upper portion of the tibia a. A series of consecutive patients with bicondylar tibial plateau fractures treated by open reduction and internal fixation with a double buttress.
Tibial plateau fracture using anterolateral approach vumedi. Tplo, also known as tibial plateau leveling osteotomy, is a surgical procedure in which the head of the tibia is surgically altered and plated to create a new joint angle. Tibial plateau fracture sports injuries, treatment and. This thesis focused on mdct and mri of knee injuries. Apr 20, 2020 tibial plateau fractures may be either lowenergy or highenergy. The longterm functional outcome of operatively treated tibial plateau fractures. The standard frosch approach was performed on 5 freshfrozen cadavers. This book is a concise handbook on key information about the diagnosis and treatment of tibial plateau fractures.
Lowenergy fractures occur in osteoporotic bone and typically are depressed fractures. The tibial plateau is one of the most critical loadbearing areas in the human body. For example, in a recent morphological study of 75 cases of schatzker type iv tibial plateau fractures, yang et al 16 found that 27 84% of 32 posteromedial fractures were characterized by a. A tibial plateau fracture is a bone fracture or break in the continuity of the bone occurring in the proximal part of the tibiaor shinbone called the tibial plateau. But posterior tibial plateau fracture ptpf is a relatively uncommon injury, with an incidence of 28.
Tibial plateau fractures make up approximately 1% of all fractures in the general population and about 8% of fractures in the elderly. The purpose of this study was to determine what patient and injury factors are associated with the presence of a meniscus tear in tibial plateau fractures. Ice and modalities to reduce pain and inflammation use crutches nonweight bearing for 6 weeks brace for 6 weeks in full extension elevate the knee above the heart for the first 3. Injuries to the lateral part of the tibial plateau are most common, and typically involve. This approach is typically utilized for splitdepression lateral plateau schatzker type ii and bicondylar schatzker type vi, type v fracture patterns. Introduction one of the most critical loadbearing areas in the human body. Some scholars thought that, in double condyle fractures of tibial plateau, incidence of posteriormedial block fracture was 59%. Feb 05, 2016 management of tibial plateau fracture 1. Tibial plateau fractures may be lateral, medial, or bicondylar. Anatomy the tibial plateau is the proximal end of the tibia including the metaphyseal and epiphyseal regions as well as the articular surfaces made up of hyaline cartilage. Ice and modalities to reduce pain and inflammation use crutches nonweight bearing for 6 weeks brace for 6 weeks in full extension elevate the knee above the heart for the first 3 to 5 days initiate patella mobility drills. Among these patients, 15 6% had fractures of the posterolateral tibial plateau, all of which were followed up for this study. Jun 11, 2010 from january 2004 to december 2008, 230 patients with tibial plateau fractures were operated on at our institution. A new angle is created in the stifle to prevent the femur from sliding off of the tibia.