From the Guidelines
When evaluating a patient with a suspected tibial plateau fracture, it is crucial to obtain a comprehensive history focusing on the mechanism of injury, timing, and associated symptoms, as this information is essential for determining the fracture pattern, energy involved, and potential additional bone or soft-tissue injuries, as noted in the American College of Radiology's appropriateness criteria for acute trauma to the knee 1. To gather relevant information, begin by asking about the exact mechanism of injury, such as a direct blow, fall from height, motor vehicle accident, sports injury, or twisting injury. Inquire about the timing of the injury and whether the patient heard or felt a "pop" or "crack." Ask about pain characteristics, including location, severity (on a scale of 1-10), and exacerbating or alleviating factors. Determine if the patient could bear weight immediately after the injury or if they experienced instability, locking, or giving way of the knee. Some key points to consider when taking the patient's history include:
- Previous injuries or surgeries to the affected knee or leg, as these may impact treatment decisions and rehabilitation planning
- Pre-existing conditions, such as osteoporosis, diabetes, or peripheral vascular disease, which may affect healing
- Medications the patient takes regularly, particularly anticoagulants, steroids, or osteoporosis medications, which may influence treatment options
- Open wounds, neurovascular symptoms (numbness, tingling, coolness), and compartment syndrome signs (severe pain, paresthesia, pallor, pulselessness, paralysis), which require prompt attention
- The patient's functional baseline, occupation, activity level, and social support, as these factors influence treatment decisions and rehabilitation planning, and are supported by the use of CT scans to further characterize fracture severity and predict potential ligamentous and meniscal injuries 1. A thorough history is essential for guiding further imaging and treatment decisions, and for ensuring the best possible outcomes in terms of morbidity, mortality, and quality of life for patients with tibial plateau fractures, as emphasized by the American College of Radiology's guidelines for acute trauma to the knee 1.
From the Research
Relevant History for Tibial Plateau Fracture
To assess a patient with a tibial plateau fracture, it is essential to take a thorough history, including:
- Mechanism of injury: The presentation of tibial plateau fractures can vary greatly as a result of the bimodal mechanism of injury and patient characteristics 2
- Patient characteristics: Age, medical history, and activity level can influence the treatment and outcome of tibial plateau fractures 2
- Symptoms: Pain, swelling, and limited mobility are common symptoms of tibial plateau fractures 2
- Previous injuries or conditions: Previous knee injuries or conditions, such as osteoarthritis, can affect the treatment and outcome of tibial plateau fractures 3
Classification and Treatment
The Schatzker classification is commonly used to classify tibial plateau fractures, which can guide treatment decisions 2, 4:
- Treatment options: Conservative management, open reduction and internal fixation (ORIF), or external fixation may be considered, depending on the severity and classification of the fracture 2, 3, 5
- Surgical approaches: The anterolateral approach is a common approach for ORIF of tibial plateau fractures, allowing for visualization of the lateral joint and metaphysis 4
- Complications: Infection, wound necrosis, and post-traumatic arthritis are potential complications of tibial plateau fractures, particularly with ORIF 2, 3, 5
Associated Injuries
Tibial plateau fractures can be associated with other injuries, such as:
- Anterior cruciate ligament (ACL) injuries: Treatment of tibial plateau fractures with associated ACL injuries can be challenging, and may require a one-stage or two-stage reconstruction surgery 6
- Meniscal injuries: Meniscal removal or repair may be necessary in some cases of tibial plateau fractures 2, 3