Pdf the management of complex tibial plateau fractures is ever evolving. It can occur in elderly patients with a low energy injury as the medial tibial plateau crumbles into fragments or in. At our institution ct imaging is utilized for preoperative management of split depression, bicondylar, and. Tibial plateau fractures musculoskeletal medicine for. Type i fracture in a 12yearold boy who experienced trauma to the lateral knee. Pdf tibial plateau fractures are complex injuries produced by high or lowenergy trauma. Tpfs and the type of material that is best for the filling of subchondral. Pdf whats new in the management of complex tibial plateau. Isolated posterior approaches do not allow sufficient visual control of fracture reduction, especially if the fracture is complex. The conservative treatment of fractures of the lateral tibial plateau has in our experience produced an excellent functional result. Arthroscopyassisted percutaneous fixation is the treatment of choice in schatzker types 1, 2, 3, and 4 fractures, as it ensures optimal reduction and stable fixation consistent with early mobilisation. Tibial plateau fractures make up approximately 1% of all fractures in the general population and about 8% of fractures in the elderly. Controversies in the management of tibial plateau fractures.
Temporary management of periarticular tibial fractures. Jul 23, 2019 a tibial plateau fracture is a break to the upper surface of the tibia shin bone. Manual traction and varusvalgus correction is performed in order to obtain. Rehabilitation guidelines for tibial plateau fracture 4 p a g e cardiovascular exercises treadmill running, bike, ube progression criteria independent with hep passing score on return to sport test with low risk of reinjury reported return to sport references. Current management of highenergy tibial plateau fractures robert d. A tibial plateau fracture refers to a break or crack in the top of the shin bone, at the knee.
Describe initial evaluation and management identify common fracture patterns apply treatment principles and strategies partial articular fractures complete articular fractures discuss rehabilitation, complications, and outcomes illustrate selected tibial plateau cases. Tibial plateau fracture symptoms, causes, treatment. Conventional methods for arthroscopic meniscal suturing are used. A comprehensive classification of tibial plateau fractures should group fractures that are similar in topography, morphology, and pathogenesis, requiring similar treatment, and having a similar prognosis. Rehabilitation from tibial plateau knee surgery healthfully. It can occur in elderly patients with a low energy injury as the medial tibial plateau crumbles into fragments or in young people with high velocity accidents. Establishment of classification of tibial plateau fracture associated with proximal fibular fracture. Ice and modalities to reduce pain and inflammation. Tibial plateau fractures are one of the commonest intraarticular fractures because of circuitous coronal or direct pivotal compressive powers. The tibial plateau is located on the upper surface of your tibia just below your kneecap. The fracturedislocation mechanism of type iv fractures. Tibial plateau fractures tpfs represent a complex group. Tibial plateau fracture management patient information 49 year old male, found on the sidewalk, unable to walk. A study of conservative management of tibial plateau fractures.
Physical examination after orif of the plateau fracture revealed a grade 3 lachman, varus laxity at both 0 and 30 degrees of knee flexion, and 15 degrees of external rotation asymmetry at 30 degrees of knee flexion. Nonoperative and operative treatment plans are considered by doctors to achieve this. Tibial plateau fractures are serious articular fractures that are challenging to treat. Correlation between radiological and clinical results clinical result radiological result total. Fractures around the knee joint very crucial for surgical management especially tibial plateau fracture management is paramount importance. Inevitably, their management varies and depends mainly on the fracture pattern and the condition of the surrounding soft tissues. Careful analysis of the fracture pat tern should be performed before undertaking the procedure. This article gives an overview of tibial plateau fractures, including anatomy, and presents a case study to analyse critically the management of a patient with this injury and the care provided by.
Basketball fans pondered the fate of kobe bryant after the lakers announced that the star player was out for the season with a lateral tibial plateau fracture. Introduction one of the most critical loadbearing areas in the human body. Plateau fracture with metaphyseal diaphyseal dissociation. With appropriate medical guidance, patient rehabilitation is possible. The full text of this article is available in pdf format. Patients who underwent orif for tibial plateau fracture from 2009 to 2012 were identified in the american college of surgeons national surgical quality improvement program acsnsqip. In general, tibial plateau fractures are to be operated on, but the decision whether to operate or not on a specific fracture should be based on the fracture morphology, the soft tissues and the patients general condition, and the expected limb axis and articular surface restoration. Aug 09, 2016 management of tibial plateau fracture 1. Schatzker classification of tibial plateau fractures.
A tibial plateau fracture in a 40yearold male with extensive. Fracture dislocations and standard tibial plateau fractures should be incorporated into a single classification to avoid the use of two complementary. Arthroscopy assisted operative management of tibial plateau fractures. Acute management of complex tibial plateau fractures with dual lateral and medial plating that is placed via a single anterior incision. Post tibial plateau fracture osteoarthritis is common approximately onethird of all tibial plateau fractures due to the articular surface being involved, despite the age of the patient at the time of fracture. A new approach to surgical management of tibial plateau fractures. Maintain a high clinical suspicion for obtaining additional imaging or ct for patients unable to bear weight in the ed following injury. Tibial plateau fractures commonly occur as a result of motor vehicle accidents in younger individuals and as a result of osteoporosis in elderly women. Pdf a new approach to surgical management of tibial. Complete restoration of function has always been the ultimate goal in the treatment of fractures and joint injuries. Oct 17, 2017 tibial plateau fractures form a wide spectrum of injuries presenting varying challenges to the trauma surgeon. Tibial plateau fractures orthopaedic trauma association.
Between may 2012 and july 2015, 12 cases of posterolateral tibial plateau fractures were treated by open reduction and plate fixation via standard and modified frosch approaches. The aim of treatment for fractured tibial plateau or tibial plateau fractures is achieving painless, aligned, stable and mobile joint and minimisation of posttraumatic osteoarthritis risks. It involves the cartilage surface of the knee joint. Anywhere from 5570% of tibial plateau fractures are isolated lateral plateau fractures, 1025% involve only the medial plateau, and 1030% are bicondylar fractures.
The study was aimed to identify the role of surgical treatment of tibial plateau fractures, its functional outcome, and complications. Controversies in the management of tibial plateau fractures pc pelser mbchb registrar, department of orthopaedic surgery, university of the free state. This fracturedislocation classification system of five types does not fit with the schatzker classification. Conservative treatment of tibial plateau fractures. Osteoporotic fracture management 68 year old female with a tibial plateau fracture kandice beenken, do otfc 2019, 2. This book is a concise handbook on key information about the diagnosis and treatment of tibial plateau fractures. The patient and a posteromedial approach on day 2 postinjury. Post tibial plateau fracture osteoarthritis is common approximately onethird of all tibial plateau fractures due to the articular surface being involved, despite the age of the patient at the time of fracture physical therapy management. Management of proximal tibial fractures springerlink. Restore joint congruity preserved normal mechanical axis sta. See overview of stress fractures and overview of tibial fractures in children and general principles of fracture management. Mikkelsen 1 has classified 18 types of fracture involving the proximal articular surface of the tibia.
Pdf a study of conservative management of tibial plateau. The tibial plateau is prone to becoming fractured in highspeed accidents such as those associated with skiing, horse riding, and certain water sports. The most common mechanism of injury is motor vehicle accident. The aim of this article is to highlight the advances in management of tibial plateau fracture over the past year. Proximal tibial fractures constitute a grossly heterogeneous group of bony injuries. Tibial plateau fracture phase i maximum protection 0 to 1 weeks.
Review of the classification systems, management, and outcome. The prognosis of this injury spectrum is largely dependent on the management of each particular configuration, and the literature is as a result littered with a number of management strategies with limited consensus. Tibial plateau fractures can have subtle radiographic findings. Avoiding complications in tibial plateau fractures henry dolch do orthopaedic trauma service. This is due to the associated soft tissue injury that often occurs. The treatment of the softtissue injuries that so often accompany tibial plateau fractures. Patients will be in a hinged brace for support and to serve as a reminder not to weightbear. In the first stage of rehabilitation from a tibial plateau fracture, your knee must be immobilized for six to eight weeks to allow your tibial plateau to heal.
However, three types of fractures generally occur in the lateral plateau, as follows. Meniscal tears are sutured under arthroscopic guidance after fracture stabilisation whenever possible. Childhood fracture management education powerpoint presentation 30. The clinical study of surgical management of tibial plateau. The goal is to allow for restoration of length, alignment, and rotation to facilitate final fracture fixation and management. Jones 2,3,y, karim kantar 1, heleen du toit 2, markus p. Exclusion criteria were undisplaced, open, and pathological fractures, fracture extension into. Classify fracture patterns of tibial plateau using schatzker and ao.
However, although arthroscopic management of selected tibial plateau fractures appears to be effi cacious, not all plateau fractures are amenable to this technique. Pdf treatment strategy for tibial plateau fractures. Type iv is a fracture of the medial tibial plateau and carries the worst prognosis of all types. Tibial plateau fractures can be successfully fixed utilizing 3. Osteoarthritis is a frequent complication of these fractures. But one should remember that any type of tibial plateau fracture can present with softtissue complications. Jan 29, 2019 a tibial plateau fracture refers to a break or crack in the top of the shin bone, at the knee. Schatzker classification of tibial plateau fractures rsna. Iliac autograft for reconstruction of severely depressed fracture of a lateral tibial plateau. Management of soft tissue injuries associated with tibial. Surgical management of tibial plateau fractures a clinical. Surgical management of tibial plateau fractures by various. Bone healing and fracture description and general principles of definitive fracture management and basic techniques for splinting of musculoskeletal injuries.
Tibial plateau fractures are intraarticular fractures of the knee that are often. Pdf a new approach to surgical management of tibial plateau. Nov 28, 2018 the tibial plateau is located on the upper surface of your tibia just below your kneecap. Tibial plateau fractures have been studied and reported extensively and exhaustively but still controversy exists over its management, whether surgical or conservative. Case report treatment of posterolateral tibial plateau. Pdf tibial plateau fractures are complex injuries produced by high or low energy trauma.
In some more complex cases, fractures can be managed by external fixation followed by further orif at a later time. The clinical study of surgical management of tibial. Rg volume 29 number 2 markhardt et al 587 figure 2. Schatzker classification system is one method of classifying tibial plateau fractures increase in type number denotes increasing severity, reflecting an increase in energy imparted to the bone at the time of injury and also an increasingly worse prognosis 1. Always seek immediate medical attention after incurring a tibial plateau injury. Jan 22, 2019 the aim of treatment for fractured tibial plateau or tibial plateau fractures is achieving painless, aligned, stable and mobile joint and minimisation of posttraumatic osteoarthritis risks.
Restore joint congruity preserved normal mechanical axis stable joint restore knee motion 3. May 31, 2016 tka can be the primary treatment of complex patterns in specific thirdage patients. The tibial plateau is one of the most critical loadbearing areas in the human body. Functional outcome after tibial plateau fracture osteosynthesis. Patients suffering a tibial plateau fracture should be aware of the residual pain and functional limitations that can appear in the mid and longterm. Fractures of tibial plateau constitute 8% in the elderly and 1% of all. Current management of highenergy tibial plateau fractures.
Combined cleavage and compression fracture of the lateral tibial plateau type i fracture with depression depression is measured between the lowest point on the intact medial plateau and the lowest depressed lateral plateau fracture fragment 25% of all tibial plateau fractures injury usually occurs in bone with underlying. Biomechanical comparison of platescrew and screw fixation in. Journal of clinical medicine article a new approach to surgical management of tibial plateau fractures stuart a. Type iv medial tibial plateau fracture type v bicondylar tibial plateau fracture type vi bicondylar tibial plateau fracture with metaphysealdiaphyseal dissociation 230 r.
Acute management of complex tibial plateau fractures with dual lateral and medial plating that is placed via a single anterior incision referred to as the deadbone sandwich has resulted in a high rate of softtissue complications. Finally, unless the fixator is used for definitive management of the fracture. Tibial plateau fractures initial management guidelines. Gait characteristics and quality of life perception of patients following tibial plateau fracture. Elevate the knee above the heart for the first 3 to 5 days.
Tibial plateau fractures form a wide spectrum of injuries presenting varying challenges to the trauma surgeon. Place these posters in your clinical areas as a visual reminder of the resources available. In treating a lateral splitdepression type tibial plateau fracture. Solomon 1,2 1 department of orthopaedics and trauma, royal adelaide hospital, adelaide, sa 5000, australia. Early detection and appropriate treatment of these fractures are critical for minimizing patient disability and reducing the risk of documented complications, particularly posttraumatic ar. Right bicondylar tibial plateau fracture and compartment syndrome implants used jetx 10. A new approach to surgical management of tibial plateau. The severity of the injury to the surrounding soft tissues influence the. Medial tibial plateau fractures, bone model, fixation. Therefore, the aim of this work was to present a surgical approach for posterolateral tibial plateau fractures that both protects the soft tissue. Sound evidence indicates that meniscal preservation during the management of tibial plateau fractures governs the medium and longterm outcomes. Tka can be the primary treatment of complex patterns in specific thirdage patients.
596 796 1442 314 1057 995 503 485 1256 133 998 1315 1539 1475 756 529 1252 508 878 622 90 1385 302 1483 1559 643 110 1100 1468 1581 756 727 758 1289 589 589 955 1413 1236 1408 349 1041 989