Navigating the Depths of Tibial Plateau Fractures

A tibial plateau fracture occurs when there is a fracture (break) at a specific area called the tibial plateau, which is at the top of the tibial bone, also called the shin bone. These injuries are frequently caused by high-energy impact injuries, leading to fractures at different areas of the tibial plateau. Let's examine the initial evaluation process, treatment options, and whether physical therapy is necessary.

Key takeaways:

Anatomy of tibial plateau fractures

Anatomy of tibial plateau fractures

The figure above shows the normal bones of the knee in the left image and then the three types of tibial plateau fractures in the other images. The tibial plateau is the flat part of the tibial bone.

With a tibial plateau fracture, the adjacent soft tissues are usually injured (not shown in the diagram), including the ligaments, tendons, nerves, connective tissue, and cartilage.

Causes of tibial plateau fractures

An injury to the outside (lateral aspect) is usually the result of a direct blow like those those injuries from athletic competitions.

Injuries to the middle side of the knee (medial tibia) are more likely to be caused by very high-energy mechanisms like falling from a height and landing on your feet. A motor vehicle accident can also cause this type of injury.

A low-energy tibial plateau fracture is usually related to people with bone thinning disorders, like osteoporosis or osteopenia.

Symptoms of tibial plateau fracture

The most common symptom of tibial plateau fracture is pain with weight bearing, walking, or running. Other symptoms include knee swelling, decreased range of motion, or a visual deformity of the knee.

In some cases, when there is pressure on the nerves, neuropathy can result in numbness and tingling of the lower leg and foot.

Diagnosis of tibial plateau fracture

The steps in making the diagnosis of tibial fracture include:

1. History

The patient needs to be questioned regarding a high-impact type of injury and when the symptoms started. In addition, history should be checked to see if there are any predisposing factors, such as osteoporosis.

2. Physical exam

  • The skin is checked to ensure no open wounds, cuts, or perforations. A skin breakage turns a fracture into a much more serious condition.
  • A visual inspection is done for the swelling of the knee.
  • The movement and range of motion of the knee should be evaluated.
  • Pulses and sensations should be checked in the foot and lower leg.

3. Imaging studies

There are different radiological tests available. Plain X-rays are the first line of imaging studies to be done since they are inexpensive and readily available. These X-rays show the alignment and structures of the bones. In addition, they can show a narrowing of the joint space.

Sometimes, the X-rays can demonstrate sclerosis, a thickening of the edge of the bone from wear and tear.

However, not all tibial plateau fractures are visible on plain X-rays. Therefore, a computer tomography (CT or CAT) scan may be needed since it allows a much more detailed view to demonstrate the fracture and its size, shape, fragmentation, and patterns, which can be important when planning surgery.

A magnetic resonance imaging (MRI) test produces detailed images of the bones and detailed images of the soft tissue structures, including the tendons, ligaments, nerves, and cartilage.

Treatment of tibial plateau fracture

Treatment can be non-surgical (conservative) or surgical to achieve proper alignment and stabilization of the knee, minimize damage to the soft tissue structures, and decrease pain.

1. Non-surgical treatment

This type of treatment would be reserved for fractures with minimal displacement, in which the bones are not significantly moved out of place, as seen with the low-energy types of tibial plateau fractures.

Conservative treatment consists of a hinged knee brace with plain X-rays every 3 weeks until complete healing is present, which usually takes about 12 weeks.

2. Surgical treatment

For surgical stabilization of the fracture, the surgeon can attach screws or plates. They usually open the skin and outer soft tissue structures to apply this metal hardware.

Is physical therapy (physiotherapy) needed?

Yes, physical therapy is needed after a tibial plateau fracture since it helps with recovery.

In both surgical and non-surgically treated cases, physical therapy can be helpful in the rehab process. In both situations, passive knee range of motion (the therapist moves the limb) can be started immediately, but no weight bearing for 6–8 weeks. This is followed by partial weight bearing for 6 weeks and then full weight bearing as tolerated.

After full weight bearing, physical therapy can focus on exercises for strength training of the stabilizing knee muscles.

Physical therapy and rehab exercises can be done independently after instructions from a qualified physical therapist.

Other diagnoses to consider

There are other diagnoses to consider when there is a knee deformity and swelling, including a medial or lateral meniscal tear, an anterior cruciate ligament (ACL) tear, or injuries to the collateral (side) ligaments.

In conclusion, tibial fractures usually occur from high-energy injuries; CT scans and MRIs best evaluate them. Surgical and non-surgical treatments followed by physical therapy assist in the recovery process.

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