Diagnosis & Treatment for Fractured Tibial Plateau or Tibial Plateau Fractures

The occurrence of fractured tibial plateau or tibial plateau fractures is during events that are commonly unpredictable like, sport related injuries, motor vehicle accidents and falling from substantial height. The prevention of such events cannot be attained. Adherence to the safety precaution can help in avoiding major injuries like using seat beats, proper techniques when playing sports and wearing protective equipment. Let us read about the complications, diagnosis and treatment of fractured tibial plateau or tibial plateau fractures.

A combination of applied forces of varus/valgus and axial results in a fractured tibial plateau or tibial plateau fractures which leads to unstable fixation, mal-alignment posttraumatic osteoarthritis increased risk and particular depression.

The complication in tibial plateau fractures which is complex are associated with malunion and non-union due to comminution, bone graft failure, unstable fixation or all these factors combined. Due to rapid technological advancements, these are rare.

Infection is the complication that is associated with tibial plateau management that is most devastating. Soft tissue and surgical timing can reduce its incidence.^[1]

Lateral knee projection and standard anteroposterior (AP) and standard identification modes are used for majority of tibial plateau fractures. Injury missed zones can occur due to rotational mal-alignment and also estimation of articular depression that is inaccurate.

The visibility of minimally displaced split fractures which are vertical via a lateral radiograph because the fracture line is lying in a plane which is oblique. On suspecting a fracture on no displaced tibial plateau oblige projection ought to be added if it is not seen on standard projections.^[2]

CT (Computed Tomography) can acquire thin axial slices of the knee and reconstruction of the image information in the coronal and sagittal planes, which provides information more detailed for fractured tibial plateau or tibial plateau fractures. The surgical approach will be based on the information attained from the CT scan. The fracture planes will also be visible through the computer images. A more accurate and better demonstration of the fracture of the tibia plateau is yielded by three-dimensional CT reconstruction which is spiral.^[3]

MRI (Magnetic Resonance Imaging) is appreciated for fractured tibial plateau or tibial plateau fractures as an accurate and reliable meniscal, cruciate and collateral ligamentous injury assessment tool and also identification of tibial plateau occult fractures.

MRI’s major advantage over CT is that ionising radiation is not used in magnetic resonance imaging. The negative aspect is the cost and the duration of completing (20 seconds for CT vs. 25 minutes of MRI), meaning that the problem can be the motion artefact.

Other tests not involving the broken leg, may be ordered by the doctor to ascertain that no other part of the body is injured (chest, belly, head, other leg, arm and spine). The blood supply of the leg is sometimes checked through other studies.^{[3] [4]}

The aim of treatment for fractured tibial plateau or tibial plateau fractures is achieving painless, aligned, stable and mobile joint and minimisation of post-traumatic osteoarthritis risks. Non-operative and operative treatment plans are considered by doctors to achieve this. Neurological and vascular compromise, extent of injury to menisci and ligaments, displacement and depression fracture, risk of complications and severity are physical criteria to base the compromise.

Inside the ward reaction procedure should be performed. This can either be skeletal traction or skin traction. The stability and the body weight of the patient will determine. Schantz pin should be inserted over the calcaneum from medial to lateral part when the condition has stabilized. Lag Screw and Buttress Plating is the fixation as defined.

• RICE technique can be applied.^[5]
• Medical assistance should be sought immediately
• Depending on the severity and the nature of the injury, there are 6 different classifications of tibial plateau fractures in surgical terms. However, broadly the fractures of the tibial plateau can be classified into two main groups: Displaced and Non-displaced fractures.

In this type of fracture, the tibial plateau or the tibia is fractured without any bone fragment separation. Non displaced fractured tibial plateau or non displaced tibial plateau fractures have a better prognosis than displaced fractures and often heal within 3-4 months without any surgical intervention, but the patient should not bear weight on the injured side and should wear a knee brace on the injured leg. Physical therapy and rehabilitation exercises are required to maintain strength of the leg and should be continued throughout the recovery phase.

In this type of fracture, the tibial plateau or the tibia breaks into two or more fragments. Surgery is usually required for displaced fractured tibial plateau or displaced tibial plateau fractures to re-fix the fragments in place and to promote proper healing of the bone tissue. The bones are fixed in place by placing screws and/or plates in and around the broken bone fragments to keep them secure. Recovery after the surgery to treat Displaced- Fractured Tibial Plateau or Tibial Plateau Fractures can take a number of months. The patient should not bear weight on the injured side for a long period of time. If there have been soft tissue injuries, then the recovery process takes longer time.

The methods available for the surgeon to use in obtaining the alignment of bone fragments that are broken and keeping them in place as they heal are internal fixation or external fixators.

Proximal tibia fracture (Left). (Right) use of (intramedullary nail) in treating the same fracture type.

Internal Fixation: Reduction (repositioning) of the fragments to their former position is done during this procedure. Plates and screws or intermedullary rod are the special devices that hold it together.

In instances that the upper quarter of the tibia has been broken, and the joint is uninjured, a plate or rode is used in the stabilization of the fracture. At the centre of the bone where the hollow medullar cavity is located is where the rod will be placed.

In fractures entering the joint, screws and plates are used commonly. If the bone is pushed down by a fracture that has entered the joint, the junction can be restored by lifting the bone fragment. A hole will be created at the region of cancellous bone due to lifting fragments. Material should be used to fill the hole and prevent the bone not to collapse. The material can be from a bone bank or from graft from the patient. Naturally occurring or synthetic products stimulating bone healing might be used also.

External Fixators: When soft tissues are affected, the condition might worsen in some cases. The final viable treatment is an external fixator. After the injury has healed, the external fixator can be removed.^[6]

References:

Team PainAssist

Written, Edited or Reviewed By: Team PainAssist, Pain Assist Inc. This article does not provide medical advice. See disclaimer

Last Modified On:July 23, 2020