A tibial plateau fracture is a bone fracture or break in a specific part of the tibia or shinbone called the tibial plateau; This is the part of the bone that is part of the knee ans is thus more serious then an average fracture. This type of fracture affects knee joint, stability and motion. The tibial plateau is a critical weight-bearing area located on the upper extremity of the tibia and is composed of two slightly concave “condyles” separated by an intercondylar eminence and the sloping areas in front and behind it. It can be divided into three areas: the medial tibial plateau (the part of the tibial plateau that is nearer to the center of the body and contains medial condyle), the lateral plateau (the part of the tibial plateau that is farthest away from the center of the body) and the central tibial plateau (located between the medial and lateral pleateaus and contains intercodylar eminence). Depending on the injury pattern, lesions may be restricted to the tibia or may have significant soft tissue injury as well as injuries to the meniscus or ligaments in the knee. However, a standard tibial plateau fracture involves either cortical interruption, depression or displacement of the articular surfaces of the proximal tibia without significant injury to the capsule or ligaments of the knee.
Tibial plateau fractures may be divided into low energy or high energy fractures . Low energy fractures are commonly due to osteoporotic bone changes. High energy fractures are commonly the result of an external trauma blow to the knee such as those caused by motor vehicle accidents, falls or sports related injuries. These causes constitute the majority of tibial plateau fractures in young individuals.
*adapted from wikipedia*
Physicians use classification types to assess the degree of injury, treatment plan and predict prognosis. Currently, the Schatzker classification system is the most widely accepted and used. It is composed of six condyle fracture types classified by fracture pattern and fragment anatomy. Each increasing numeric fracture type denotes increasing severity. The higher the number, the worse the injury generally is. The severity correlates with the amount of energy imparted to the bone at the time of injury and prognosis.
Schatzker classification for tibial plateau fracture:
- Type I = Lateral Tibial plateau fracture without depression.
This is a wedge-shaped pure cleavage fracture and involves a vertical split of the lateral tibial plateau. It is usually the result of a low energy injury in young individuals with normal mineralization. May be caused by a valgus force combined with axial loading that leads to the lateral femoral condyle being driven into the articular surface of the tibial plateau. Represent 6% of all tibial plateau fractures.
- Type II = Lateral tibial plateau fracture with depression,
This is a combined cleavage and compression fracture and involves vertical split of the lateral condyle combined with depression of the adjacent load bearing part of the condyle. Caused by a valgus force on the knee; it is a low energy injury, typically seen in individuals of the 4th decade or older with osteoporotic changes in bone. Most common, and make up 75% of all tibial plateau fractures. There is a 20% risk of distraction injuries to the medial collateral ligament. May include distraction injury to the medial collateral ligament or anterior cruiciate ligament.
- Type III: Focal depression of articular surface with no associated split.
This is a pure compression fracture of the lateral or central tibial plateau in which the articular surface of the tibial plateau is depressed and driven into the lateral tibial mataphysis by axial forces.3 A low energy injury, these fractures are more frequent in the 4th and 5th decades of life and individuals with osteoporotic changes in bone. They are extremely rare. Can be further divided into two subtypes: IIIA Compression Fracture of the lateral tibial plateau IIIB Compression Fracture of the central tibial plateau May result in joint instability.
- Type IV = Medial tibial plateau fracture, with or without depression; may involve tibial spines; associated soft tissue injuries.
This is a medial tibial plateau fracture with a split or depressed component. It is usually the result of a high energy injury and involves a varus force with axial loading at the knee. Reperesent 10% of all tibial plateau fractures. There is high risk of damage to the popliteal artery and peroneal nerve and therefore carry a worse prognosis. May include distraction injuries to lateral collateral ligament, fibular dislocation/fracture, posterolateral corner.
- Type V = Bicondylar tibial plateau fracture,
Consists of a split fracture of the medial and lateral tibial plateau. It is usually the result of a high energy injury with complex varus and valgus forces acting upon the tibial plateau. May include injuries to the anterior cruciate ligament and collateral ligaments. Make up 3% of all tibial plateau fractures.
- Type VI = Tibial plateau fracture with diaphyseal discontinuity
Main feature of this type of fracture is a transverse subcondylar fracture with dissociation of the metaphysis from the diaphysis. The fracture pattern of the condyles is variable and all types of fractures can occur. This is a high energy injury with a complex mechanism that includes varus and valgus forces. Up to 33% of these fractures may be open, often with extensive soft tissue injuries and risk of compartment syndrome. Represents 20% of all tibial plateau fractures.
Tibial plateau fractures typically presents swelling of the knee soft tissues and inability to bear weight. The knee may be deformed due to displacement and/or fragmentation of the tibia which leads to loss of its normal structural appearance (This is part of the reason you might need surgery). Blood in the soft tissues and knee joint (hemarthrosis) may lead to bruising and a doughy feel of the knee joint. Due to the tibial plateau’s proximity to important vascular (i.e. arteries, veins) and neurological structures, injuries to these may occur upon fracture. A careful examination of the neurovascular systems is imperative. A serious possible complication of tibial plateau fractures is compartment syndrome in which swelling causes compression of the nerves and blood vessels inside the leg.
There are several types of complications possible resulting from a Tibial Plateau fracture. The most common are “compartment syndrome” and “post-traumatic arthritis”.
Compartment syndrome is a complication that usually occurs very near the time of the original injury, and involves a sudden bleeding into the tight tissue lower limb sufficient to obstruct the blood flow in the veins. The increasing pressure inside the muscle compartments can lead to damage to the muscle tissue. Compartment syndrome can be very painful, and is usually treated by an emergency surgery known as “fasciotomy”. Your doctor will likely look for signs of compartment syndrome before and after surgery. There is generally nothing to worry about weather you have compartment syndrome during the recovery, since this is a very painful situation and if you have it, you will notice.
Post-traumatic arthritis is a complication that occurs later on in the recovery process and can appear months or years after the injury, It involves grinding and wastage of cartilage in the knee joint which can be painful. This condition will either be treated symptomatically with pan medication, by injections to the knee joint or in some cases with minor surgery know as arthroscopic surgery which will help “clean up” cartilage in the knee. Arthritis is a condition from which some people suffer, especially during older age regardless of injury, so if you have arthritis of the knee, it might not be connected to the injury itself.
If the Tibial Plateau fracture is on the medial (internal) side of the knee, there are also other complications to worry about involving damage to nerves and arteries in that area. Your doctor will be checking to make sure that no damage has been caused to these tissues.
More info coming soon