Dress with saline-soaked gauze and urgently refer to orthopaedics/plastic surgery. If an open injury, macroscopic debris should be removed and medical photography arranged, no washout should be completed in AE. Indications for operative management include an articular step (depression in the surface) >3mm, condylar widening >5mm or gross instability. Operative management: open reduction and internal fixation (ORIF).Indications for non-operative management include non-ambulant patients or minimally displaced fractures with non-injured ligaments (varus/valgus stability) Nonoperative management: generally involves a hinged knee brace.They should be made non-weight bearing and elevation should be encouraged.Īll patients should be referred to and discussed with orthopaedics. Patients should be given appropriate analgesia placed in a brace or above knee plaster of Paris (POP) backslab. Acute managementĬonsider the mechanism of injury, presenting state and other associated injuries - is a trauma call required? Complete a head-to-toe assessment in all patients. The management of a tibial plateau fracture, like most acute fractures, involves analagesia and acute stabilisation of the joint followed by non-operative (conservative) or operative management. The principle of management is to restore joint stability. * NOTE: A plateau view refers to a 10 degree caudal tilt to compensate for the anatomical 10 degree posterior tibial slope. Magnetic resonance imaging (MRI): useful in diagnosing meniscal and ligamentous injury.Undertaken if there are any concerns of vascular injury (e.g. CT Angiography: allows visualisation of arterial supply to lower limbs.Also used when suspicion remains after a normal-appearing radiograph. Computed tomography of knee: allows better visualisation of articular depression and comminution (i.e.Plain X-ray may miss subtle fractures, where sufficient suspicion exists a CT or MRI should be arranged. Look out for lipohaemoarthrosis (fat and fluid within the joint) on the lateral view, which suggests an intra-articular fracture. Plain film radiograph of knee: get anterior-posterior (AP), lateral and plateau views*.CT, MRI) may be needed to exclude complications and for surgical planning. X-rays allow an initial diagnosis, but more detailed cross-sectional imaging (i.e. In trauma, if fractures are suspected they should be confirmed with appropriate radiological investigations. X-rays are typically diagnostic, CT scans have a role in surgical planning. Soft tissue: injuries to the surrounding soft tissue can contribute to joint instability.Joint surface: the incongruent joint surface increases the risk of post-traumatic arthritis.Muscular attachments: the large muscular attachments on the tibial plateau can contribute to fragment displacement following trauma.A bicondylar fracture refers to a fracture of both condyles.Īspects of the anatomy of the tibial plateau can affect the response to a fracture, these include: The lateral tibial condyle is convex in shape, compared to the concave medial side.Ī unicondylar fracture refers to a fracture of one of the condyles, the lateral condyle is more frequently affected. ![]() The medial condyle is generally larger, stronger and transmits more weight compared to the lateral condyle. The medial tibial plateau bears 60% of the load through the knee. In the elderly, low-energy mechanisms leading to fracture usually suggest insufficiency fractures due to osteoporosis. This includes open fractures, ligamentous injury and vascular damage. Importantly, high-energy mechanisms leading to a tibia plateau fracture may be associated with significant soft tissue injuries. Alternatively, a fracture can arise from a varus force, which describes an inside force pushing the knee outwards along a coronal plane. Tibial plateau fractures occur secondary to traumatic injuries Mechanismsįracture of the tibial plateau can arise from a valgus force, which describes an outside force pushing the knee inwards along a coronal plane.
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