Tibial Plateau Fractures: Mechanisms and Patterns

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.