TIBIAL PLATEAU FRACTURES.docx

Introduction Typical mechanism of axial compression with varus/valgus loading. Bimodal distribution: High-energy trauma: adult and middle-aged patients, more common in males. Low-energy falls: osteoporotic insufficiency fractures, more common in women. Lateral plateau fractures are most common, f...

Introduction Typical mechanism of axial compression with varus/valgus loading. Bimodal distribution: High-energy trauma: adult and middle-aged patients, more common in males. Low-energy falls: osteoporotic insufficiency fractures, more common in women. Lateral plateau fractures are most common, followed by bicondylar, followed by medial plateau fractures. Lateral plateau fractures: lateral meniscal pathology. Medial plateau fractures: medial meniscal pathology. Schatzker classification Type I: lateral split. Type II: lateral split depression. Type III: lateral depression. Type IV: medial plateau, possible knee dislocation equivalent. Type V: bicondylar. Type VI: metaphyseal-diaphyseal dissociation. Clinical features The patient is nearly always an adult. The joint is swollen and has the doughy feel of hemarthrosis. There is diffuse tenderness on the side of the fracture, and on the opposite side if a ligament is injured. Treatment Conservative Aspirate the hemarthrosis & apply crepe bandage followed by 10 days continuous passive motion (CPM) machine followed by 3 weeks hinged cast brace followed by 4 weeks Partial Weight Bearing (PWB) followed by Full Weight Bearing (FWB). Operative ORIF using lag screws or buttress plate + elevation of any depression & support with bone graft. Choosing the method Type І & ІV: if undisplaced → conservative. If displaced → ORI. Type II & III: If depression >5mm & young→ ORIF. if <5mm or elderly→ conservative. Type V & VІ: if severe, there is a risk of compartment syndrome. If undisplaced or slightly displaced in elderly → conservative. If displaced→ ORIF or circular frame external fixation or 6 weeks skeletal traction followed by 6 weeks PWB. Complications Early Compartment syndrome. Maintain a high index of suspicion of compartment syndrome. Most common in the anterior and lateral compartments. Increased risk with higher-energy injuries and more proximal fractures. Late Joint stiffness. Varus or valgus deformity. OA (after 5-10 years).