tibial plateau fracture Flashcards
when does a tibial plateau occur generally?
following high energy trauma e.g fall or car accident
from the impaction of the femoral condyle onto the tibial plateau
typically a varus deforming force, meaning the lateral tibial plateau is more frequently fractured than the medial side
what other injuries do tibial plateau fractures typically present with?
found alongside other bony and soft tissue injuries e.g meniscal tears or collateral ligament injury
what are the clinical features of tibial plateau fractures?
- history of trauma. get the mechanism of injury, as injury through axial loading/high impact makes diagnosis more likely
- sudden onset pain
- swelling of knee (lipohaemathrosis)
- tenderness
- potential ligament instability
- check peripheral NV status of patient as can occour in high grade injuries
what investigations are done?
First line = plain film radiographs (anteroposterior and lateral), often features on radiograph are subtle.
There will also be a lipohaemarthrosis present
CT scanning is needed in almost all cases, apart from undisplaced fractures. This help both in assessment of severity, as well as surgical planning.
how is a tibial plateau fracture managed conservatively?
can do with uncomplicated cases (e.g no evidence of ligamentous damage)
use hinged knee brace and non/partial weight baring for 8-12 weeks, with physiotherapy and analgesia
how is a tibial plateau fracture managed operatively?
if complicated/evidence of open fracture/compartment syndrme
ORIF (open reduction and internal fixation) is the mainstay with the aim to restore the joint surface congruence and ensure joint stability
postoperatively, hinged knee brace with limited/non weight bearing for 8-12 weeks
if significant trauma/polytrauma, may need external fixation
what are the complications of tibial plateau fractures?
The main long-term complication following a tibial plateau fracture is post-traumatic arthritis to the affected limb.
