What is Fractured Tibial Plateau1 or Tibial Plateau Fractures?
The tibial plateau is one of the critical areas in the human body which deals with load bearing. Motion, alignment and stability of the knee are affected by the fractured tibial plateau or tibial plateau fractures. It is critical to detect and treat these fractures at an early stage so as to minimize disability of the patient and the reduction of the documented complication, especially posttraumatic arthritis.
The upper surface of the tibia (shin bone) is the tibial plateau. This tibial plateau is highly susceptible to fracture in accidents involving high speed e.g. skiing, horse riding and some water sports.
Fractured tibial plateau or tibial plateau fractures is a serious condition as the upper surface of the bone or the tibial plateau comprises of structures, which are vital to the functioning of the knees. This is why fractured tibial plateau or tibial plateau fractures are commonly associated with anterior cruciate ligament (ACL) injuries2, collateral ligaments (MCL and/or LCL) injuries, menisci and articular cartilage injuries. Although tibial plateau fractures are treatable, they make the knee joint more prone to early onset of osteoarthritis3, especially in younger patients. These fractures also affect the stability and motion of the knee joint.
Classification4 of Fractured Tibial Plateau or Tibial Plateau Fractures
Fractured tibial plateau or tibial plateau fractures have had many classifications. A classification system was made by Schatzker et al regarding condyle structure based on the fragment anatomy and fracture pattern. The following six type of fractural division shows how the classification is widely used and accepted today:
- Type 1: Fractured tibial plateau or tibial plateau fractures which is a lateral fracture, without depression. This is a split or a wage fracture of the lateral properties of the plateau resulting usually due to axial and valgus forces; it is because there is no compression (depression) on this wedge fragment because of the strength of the underlying cancellous bone. Young patients are usually the victims of this pattern.
- Type 2: Fractured tibial plateau or tibial plateau fractures which is a lateral fracture, with depression. This is a split or wedge fracture linked with compression: the fracturing mechanism is the same of that of type I; the bone underlying may be unable in depression resistance and also osteoporotic5, or maybe was higher.
- Type 3: Articular surface’s depression with not split association. This is a fracture of the lateral plateau that is pure compression, due to its occurring following an axial force and it is either located centrally or laterally. Nevertheless, a portion of articular surface can be involved.
- Type 4: Fracture of the medial fractured tibial plateau or tibial plateau fractures, without or with depression; tibial spines may be involved; associated with injuries of soft tissues. The medial plateau is involved in this fracture; resulting either from axial or varus compression forces. A with a compression or a split alone is how the pattern is because a stronger and larger plateau fracture is involved. This type is caused by a force that is greater than those of types I, II and III.
- Type 5: Fracture of bycondylar tibia plateau. Splits elements in these fractures are of both the lateral and the medial condyle and may include lateral and medial articular compression usually resulting from a pure axial force which occurs as the knee is in extension.
- Type 6: Fracture of the tibia plateau with diaphyseal discontinuity. The separation of the component of the condyle from the diaohysis is the result of bicondular fracture. The routine is the impaction and depression of fracture fragments. The cause of this pattern is high-energy trauma and combination of forces that is diverse.
Etiology of Fractured Tibial Plateau or Tibial Plateau Fractures
Axial loading and valgus force are the common mechanism which results in fractured tibial plateau or tibial plateau fractures mostly. Injuries related to motor vehicles account for 80% of the fractured tibial plateau or tibial plateau fractures. Sports takes up the remaining related injuries. Twenty five percent of these fractures are fended or bumper related vehicle-pedestrian collision related injuries. The trauma can be related to a sports injury, industrial accident, falling from heights or a direct trauma.
Tibial plateau fractures can either be high-energy or low-energy. Low energy fractures are depressed structures typically because of occurring in the osteoporotic bone. Motor vehicle is the reason for the occurrence of high- energy fractures. Splinting fractures are most commonly related to this group because fractures in this group results because most patterns are trauma related.
Epidemiology of Fractured Tibial Plateau6 or Tibial Plateau Fractures
Patients, with a fractured tibial plateau or tibial plateau fractures who are aged 50 years and above, amounts to more than 50 percent of all cases. Older females are more vulnerable to tibial plateau fracture due the osteoporosis increased prevalence in these in these individuals and thus the increase frequency.
Causes of Fractured Tibial Plateau or Tibial Plateau Fractures
Stress can make a fractured tibial plateau or tibial plateau fractures to occur in the upper tibia (excessive activities resulting in minor breaks) or from a bone already compromised (like in infection or cancer). However trauma (injury) is the cause of most.
High-energy injury is the cause of majority of the fractured tibial plateau or tibial plateau fractures that is experienced by majority of young people; example sports trauma, a motor vehicle accident and a fall from heights that is considerable. The fractures can even occur as a result of low-energy injury in people with poor quality of bone for example even a fall.
When force is applied on your bone that it is unable to withstand fractured tibial plateau or tibial plateau fractures occurs. The causes of the injury that are common include:
- Trauma (direct hit) on your tibial plateau.
- Indirect trauma like bending or twisting injury.
Signs and Symptoms of Fractured Tibial Plateau or Tibial Plateau Fractures
- The fractured tibial plateau or tibial plateau fractures site will be severely painful, during the injury, and may last longer.
- The site of fracture will be tender, inflamed or/and contusion (bruising.)
- Knee function decreases.
- Inability to walk or stand on the injured knee.
- Deformity is seen if the alignment of the fragment is not proper (displaced fracture.)
- Vascular damage signs: coldness and numbness below the site injured.
- Inability to bear weight on the injured side.
- Stiffness in the knee.
- There may be deformation of the knee due to displacement and/or fragmentation of the tibia resulting in loss of the knee’s normal structural appearance.
- Bruising and a doughy feel of the knee joint.
- Diagnosis & Treatment for Fractured Tibial Plateau or Tibial Plateau Fractures
- Physiotherapy and Recovery for Fractured Tibial Plateau or Tibial Plateau Fractures