From the Guidelines
Treatment of a tibial plateau fracture should prioritize surgical intervention with open reduction and internal fixation for displaced fractures, and conservative management with non-weight bearing and immobilization for non-displaced fractures, as evidenced by the most recent guidelines 1. When managing tibial plateau fractures, it is essential to consider the severity of the fracture and the potential for complications such as post-traumatic arthritis, knee stiffness, and malunion.
- Non-displaced fractures can often be managed conservatively with non-weight bearing for 6-8 weeks, knee immobilization with a hinged brace, and progressive physical therapy focusing on range of motion and quadriceps strengthening.
- Displaced fractures, on the other hand, typically require surgical intervention with open reduction and internal fixation using plates and screws to restore joint congruity, as recommended by recent guidelines 1. Pain management is also crucial in the treatment of tibial plateau fractures, and may include:
- Acetaminophen 1000mg every 6 hours
- NSAIDs like ibuprofen 600mg three times daily if not contraindicated
- Short-term opioids for moderate to severe pain It is also important to consider the use of postoperative negative pressure wound therapy (NPWT) for high-risk surgical incisions, such as those following open reduction and internal fixation for tibial plateau fractures, as suggested by recent studies 1. Recovery from a tibial plateau fracture can take 3-6 months, with full weight-bearing gradually introduced based on radiographic healing.
- Early mobilization within pain limits is encouraged to prevent stiffness
- Avoiding weight-bearing until sufficient healing occurs to prevent articular surface collapse is also crucial.
From the Research
Definition and Classification of Tibial Plateau Fractures
- Tibial plateau fractures are peri-articular knee fractures of the proximal tibia, with a bimodal mechanism of injury and varying patient characteristics 2
- The tibial plateau is composed of a medial and lateral condyle separated by the intercondylar eminence, and its fractures are classified using the Schatzker classification 2, 3
Management of Tibial Plateau Fractures
- The management of tibial plateau fractures depends on the severity of the fracture, ranging from conservative to surgical management 2, 4
- Surgical management is required for more severe fractures to restore articular congruity, mechanical alignment, ligamentous stability, and permit early mobilization 2, 4
- Various operative methods have been reported, including plates, screws, external fixators, arthroscopy-assisted methods, and balloon-cement tibioplasty 4, 3
Rehabilitation and Outcomes
- Early range of motion exercises and early weight-bearing should be encouraged in the rehabilitation of tibial plateau fractures 5
- Ongoing rehabilitation with a focus on quadriceps strengthening and proprioception exercises is recommended to improve clinical outcomes 5
- Medium-term functional outcomes after tibial plateau fractures are generally excellent when anatomy and stability are restored, with at least half of patients returning to their original level of physical activity 2
Complications and Challenges
- Tibial plateau fractures can have significant complications, including postoperative arthritis, bicondylar and comminuted fractures, meniscal removal, instability, malalignment, and articular incongruity 2
- The management of tibial plateau fractures can be challenging due to the complexity of the injury and the lack of consensus on optimal management strategies 4, 3