Tibial Plateau Fractures: Mechanisms and Patterns

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11 Questions

What is the common mechanism of tibial plateau fractures?

Valgus or varus force with axial loading

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

Depressed fractures

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

To achieve anatomical reduction of the joint surface and stable osteosynthesis

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

To increase knee joint movement to prevent stiffness

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

Schatzker's Classification

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

Conservative management with full-length POP

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

Function

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

Isometric exercises only

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

To provide support and reduce weight-bearing

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

At 12 weeks

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

To maintain or improve muscle power and range of motion of unaffected limbs

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

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.

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