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Questions and Answers
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?
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What is the classification system used to categorize tibial plateau fractures?
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What is the typical treatment for undisplaced and stable tibial plateau fractures?
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What is the primary focus of the treatment plan for the operated leg from 8 weeks?
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During the initial 0-4 weeks, what type of exercises are recommended for the affected leg?
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What is the purpose of using a walking frame or crutches during the initial 0-4 weeks?
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When can the patient progress to full weight-bearing (FWB) activities?
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What is the purpose of hip ROM exercises during the initial 0-4 weeks?
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Study Notes
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
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Description
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.
