Tibial Plateau Fracture

What is a Tibial Plateau Fracture?

A tibial plateau fracture is a crack or break on the top surface of the tibia or shinbone in the knee joint. The fracture most often occurs following a high-intensity trauma or injury from the impaction of the femoral condyles over the tibial plateau.  Fractures of the tibial plateau are serious injuries that are more commonly seen in athletes involved in high-impact sports such as basketball, rugby, and football and can put athletes out of action for a long period of time.

Anatomy of Tibial Plateau

The knee is a hinge joint made up of 2 bones, the thighbone (femur) and shinbone (tibia). There are 2 round knobs at the end of the femur called femoral condyles that articulate with the flat surface of the tibia called the tibial plateau. This is a crucial weight-bearing segment of the body that attaches the thighbone to the shinbone through tough bands of tissue called ligaments. The tibial plateau on the inside of the leg is called the medial tibial plateau and on the outside of the leg, the lateral tibial plateau. The lateral side is more prone to fracture than the medial side.

Classification of Tibial Plateau Fractures

Tibial plateau fractures are classified into 6 types based on Dr. Joseph Schatzker’s recommendation and are commonly known as Schatzker classification. These include:

• Schatzker Type I: A wedge fracture of the lateral tibia plateau with displacement or depression
• Schatzker Type II: A fracture of the lateral tibia plateau with depression and splitting
• Schatzker Type III: A compression fracture of the central or lateral tibia plateau with depression
• Schatzker Type IV: A fracture of the medial tibial plateau with a depressed or split component
• Schatzker Type V: A wedge fracture of both medial and lateral tibial plateau
• Schatzker Type VI: A transverse fracture of the tibial plateau with discontinuity of diaphysis (the midsection of the tibia)

The degree of injury indicates the severity and type of fracture and helps your doctor to recommend suitable treatment option accordingly.

Causes and Risk Factors of Tibial Plateau Fracture

Some of the causes of a tibial plateau fracture include:

• Motor vehicle collisions
• Fall from a height
• Injuries from high-intensity sports, such as skiing or football
• Osteoporosis
• Bone infection
• Bone mineral deficiency

Signs and Symptoms of Tibial Plateau Fracture

Some of the signs and symptoms of a tibial plateau fracture include:

• Persistent pain in the knee joint
• Swelling and bruising
• Instability
• tenderness
• Inability to bear weight on the legs
• Decreased range of motion in the knee
• Paleness in the leg due to reduced blood flow

Diagnosis of Tibial Plateau Fracture

To diagnose a tibial plateau fracture, your doctor will review your symptoms and medical history and conduct a thorough physical examination to look for signs of swelling, bruises, rupture of the skin, instability, and other deformities. In order to confirm the diagnosis and obtain further information on the severity of the fracture, your doctor may recommend:

• X-rays: This study uses high electromagnetic energy beams that produce images of the bones to help detect fractures.
• CT Scan: This scan uses special X rays that produce clear images of any damage present in the internal hard and soft tissue structures of the body.
• MRI Scan: This study produces images that help in detecting damage to soft tissues or ligaments using large magnetic fields and radio waves.
• CT angiography: This test is done to detect the variation in pulse rate in cases with arterial injury.

Treatment for Tibial Plateau Fracture

Treatment for a tibial plateau fracture depends upon the classification of the fracture and involves both conservative as well as surgical options. These treatment options include:

• Rest: Providing ample rest to the injured knee and avoiding activities that trigger symptoms
• Ice: Application of ice packs on the joints to decrease swelling and pain
• Compression: Compressing the affected area with elastic bandages to reduce pain and swelling
• Elevation: Keeping the leg elevated above chest level helps to decrease any swelling
• Medications: Use of pain-relievers and anti-inflammatory medications, such as naproxen and ibuprofen to control pain and inflammation
• Orthotics: Use of assistive devices such as knee braces and splints to avoid weight on the injury and prevent any damage to the joint surface
• Surgery: Surgical intervention may be required if conservative treatment measures do not help and may involve use of plates and screws to realign the bone to confer stability to the joint. Recovery post-surgery may take anywhere from 3 to 6 months and varies from individual to individual depending on the severity of the tibial plateau fracture.