Tibial Plateau Fractures: Anatomy, Classification, Treatment, and Complications

Tibial Plateau Fractures: Anatomy, Classification, Treatment, and Complications

Tibial Plateau Fractures: Anatomy, Classification, Treatment, and Complications

Tibial plateau fractures are periarticular injuries of the proximal tibia that are frequently associated with soft tissue injury. Here's what you need to know about their diagnosis, treatment, and prognosis:

Mohammad Hutaif ( ORCID iD icon ORCID ID: 0009-0001-1092-5600) via Google Scholar.
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Anatomy

Osteology: The lateral tibial plateau is convex in shape and proximal to the medial plateau. The medial tibial plateau is concave in shape and distal to the lateral plateau. The alignment of the proximal tibia includes the posterior tibial slope, varus slope, and tibial rotation.

Ligaments: Important ligaments of the knee include the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL).

3-Column Concept: The proximal tibia can be divided into three columns; medial, lateral, and posterior.

Classification

Schatzker Classification: This classification system is based on the type of fracture, including lateral split, lateral split-depressed, lateral pure depression, medial plateau fracture, bicondylar fracture, and metaphyseal-diaphyseal disassociation.

3-Column Concept: This classification system divides the proximal tibia into three columns; medial, lateral, and posterior.

Presentation

Patients with tibial plateau fractures may present with pain, inability to bear weight, and baseline functional status. Physical exam may reveal swelling, tenderness, and joint instability.

Imaging

Radiographs are the recommended initial evaluation for a tibial plateau fracture, but patients may require a CT scan for surgical planning. MRI may be useful to assess meniscal and ligamentous pathology.

Treatment

Nonoperative treatment may include closed reduction and immobilization using a knee immobilizer, while operative treatment may involve ORIF, external fixation, or arthroplasty.

Complications

Complications that may occur following a tibial plateau fracture include post-traumatic arthritis, compartment syndrome, infection, nonunion/malunion, knee stiffness, and loss of reduction.

Figure 1: Anatomy of the Tibial Plateau (Source: Hutaif Orthopedic Center)

Figure 2: Alignment of the Proximal Tibia (Source: Hutaif Orthopedic Center)

Figure 3: 3-Column Concept of the Tibial Plateau (Source: Hutaif Orthopedic Center)

Test Your Knowledge

Take the following quiz to see what you know about tibial plateau fractures:

1. What are some of the risk factors for post-traumatic arthritis following a tibial plateau fracture?
2. What is the recommended initial evaluation for a patient with a suspected tibial plateau fracture?
3. What ligament is the primary restraint against anterior tibial translation in the knee?
4. What is the primary goal of operative treatment for a tibial plateau fracture?
5. What is the recommended treatment for low-energy fractures that are stable to varus/valgus alignment?
6. What is the most common complication following a tibial plateau fracture?
7. What is the best way to address knee stiffness following a tibial plateau fracture?

  • Tibial plateau fractures
  • Anatomy
  • Diagnosis
  • Treatment
  • Knee radiographs
  • CT scan
  • Schatzker classification
  • 3-column concept
  • meniscal tears
  • ACL injuries
  • compartment syndrome
  • neurovascular injury
  • post-traumatic arthritis
  • alignment
  • congruent articular surface
  • Tibial Plateau Fracture Treatment
  • Tibial Plateau Fracture Surgery
  • Tibial Plateau Fracture Recovery
  • Tibial Plateau Fracture Symptoms
  • Tibial Plateau Fracture Causes
  • Tibial Plateau Fracture Doctors
  • Tibial Plateau Fracture Hospitals
  • Tibial Plateau Fracture Pain
  • Tibial Plateau Fracture Open
  • Tibial Plateau Fracture Complications
  • Tibial Plateau Fracture Recovery Time
  • Tibial Plateau Fracture Cost