Tibial Plateau Fractures: Mechanisms and Patterns

What is the common mechanism of tibial plateau fractures?

What type of fractures are commonly associated with low-energy trauma?

What is the goal of medical management in tibial plateau fractures?

What is the primary aim of physiotherapy in undisplaced tibial plateau fractures?

What is the classification system used to categorize tibial plateau fractures?

What is the typical treatment for undisplaced and stable tibial plateau fractures?

What is the primary focus of the treatment plan for the operated leg from 8 weeks?

During the initial 0-4 weeks, what type of exercises are recommended for the affected leg?

What is the purpose of using a walking frame or crutches during the initial 0-4 weeks?

When can the patient progress to full weight-bearing (FWB) activities?

What is the purpose of hip ROM exercises during the initial 0-4 weeks?

Tibial Plateau Fractures

Common mechanism: valgus or varus force with axial loading
High-energy fractures: MVA-related injuries and sports-related injuries in young people, often resulting in splitting fractures
Low-energy fractures: insufficiency fractures related to falls in the elderly, often resulting in depressed fractures

Schatzker's Classification of Tibial Plateau Fractures

Schatzker I: Lateral split
Schatzker II: Lateral split with depression
Schatzker III: Lateral depression
Schatzker IV: Medial depression
Schatzker V: Bicondylar
Schatzker VI: Fracture of both condyles with shaft involvement

Medical Management

Aims: achieve anatomical reduction of the joint surface and stable osteosynthesis to enable early mobilization and prevent complications

Conservative Management

Undisplaced and stable fracture: full-length POP with ankle in neutral/plantar grade position for 4 weeks, followed by 4 weeks in a leg brace allowing knee ROM, and physiotherapy to improve knee joint movement

Physiotherapy

Aim: improve knee joint movement to prevent loss of joint motion or stiffness
Treatment (0-4 weeks):
- Affected leg: isometric and co-contractions of muscles around the knee joint, ankle circulation exercises, and elevation of the leg in extension
- Hip ROM exercises and strengthening exercises
- Maintain or improve ROM/muscle power of unaffected limbs
- Bed mobility and transfer from lying to sitting
- Standing with NWB on the affected leg using a walking frame/crutches
Treatment (4-8 weeks):
- Start active-assisted knee ROM flexion/extension
- Progress strengthening exercises
- Bed mobility (PWB on knee in bridging)
- Continue with crutch walking NWB
Treatment (after 8 weeks):
- Gradually increase weight-bearing activities, active ROM, and strengthening exercises on the operated leg
- Focus on functional activities

Learn about the different mechanisms and patterns of tibial plateau fractures, including high-energy and low-energy fractures, and their associated characteristics. Understand the causes and types of fractures, including valgus and varus forces, axial loading, and more.