Tibial plateau fracture
Tibial plateau fractures were originally termed a bumper or fender fracture but only 25% of tibial plateau fractures result from impact with automobile bumpers.
The most common mechanism of injury involves axial loading, e.g. fall from a significant height. In younger patients, the most common pattern of fracture is splitting, while in older, more osteoporotic patients, depression fractures typically are sustained.
Soft tissue injuries (e.g. to cruciate and collateral ligaments) occur in approximately 10% of patients.
Fractures of the lateral plateau are much more common than the medial plateau. To injure the medial plateau a large amount of force is required; fractures of the medial plateau are usually seen in conjunction with fractures of the lateral plateau and other bones around the knee joint.
Tibial plateau fractures are complex injuries that require adequate imaging to assess prior to fixation.
The severity of injury is often underestimated by plain film. Lipohaemarthrosis should be present.
CT is very helpful in accurately defining the extent of bony injury and facilitates orthopaedic intervention. The Schatzker classification is used in tibial plateau fractures.
MRI is very helpful in the assessment of soft tissue injury around the joint.
Treatment and prognosis
The goal of therapy is to reduce the fracture and begin early mobilization. If the patient is immobilized for a lengthy period (>3 weeks), the joint will not return to full range of movement.
Unappreciated ligamentous injury causes greater than normal stress on the remaining support structures of the joint, malalignment, and the development of premature osteoarthritis.
The knee is a complex synovial joint that can be affected by a range of pathologies:
- bone and cartilage
- distal femoral condyle fracture
- tibial plateau fracture (classification)
- patella fracture
avulsion fractures of the knee
- Segond fracture
- reverse Segond fracture
- anterior cruciate ligament avulsion fracture
- posterior cruciate ligament avulsion fracture
- arcuate complex avulsion fracture (arcuate sign)
- biceps femoris avulsion fracture
- iliotibial band avulsion fracture
- semimembranosus tendon avulsion fracture
- Stieda fracture (MCL avulsion fracture)
- patella fracture
- chronic avulsion injuries
- chondromalacia patellae
- osteoarthritis of the knee
- osteochondral defects
- osteochondritis dissecans of the knee
- pattern of bone contusion in knee injuries
- knee fractures
- meniscal lesions
- synovial lesions
- fat pad
- popliteal fossa
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- 2. Macarini L, Murrone M, Marini S et-al. Tibial plateau fractures: evaluation with multidetector-CT. Radiol Med. 2005;108 (5-6): 503-14. Pubmed citation
- 3. Rafii M, Firooznia H, Golimbu C et-al. Computed tomography of tibial plateau fractures. AJR Am J Roentgenol. 1984;142 (6): 1181-6. AJR Am J Roentgenol (abstract) - Pubmed citation
- 4. Rafii M, Firooznia H, Golimbu C et-al. Computed tomography of tibial plateau fractures. AJR Am J Roentgenol. 1984;142 (6): 1181-6. AJR Am J Roentgenol (abstract) - Pubmed citation