From the Guidelines
Non-displaced tibial plateau fractures should be treated with simple immobilization when fracture fragments are small, nonarticular, or minimally displaced. This approach is supported by the American College of Foot and Ankle Surgeons, as stated in a study published in the American Family Physician in 2002 1. The treatment priorities for non-displaced tibial plateau fractures focus on minimizing morbidity, mortality, and optimizing quality of life.
Key considerations for treatment include:
- Weight-bearing restrictions with partial or non-weight bearing for 6-8 weeks to reduce stress on the fracture site
- Use of crutches or a walker for support during mobility
- A hinged knee brace to provide stability while allowing controlled motion for 6-8 weeks
- Early range of motion exercises to prevent stiffness, starting with 0-90 degrees and progressing as tolerated
- Pain management using NSAIDs like ibuprofen or naproxen, combined with acetaminophen for the first 1-2 weeks
- Regular follow-up with orthopedics at 2,6, and 12 weeks to monitor healing with serial X-rays
- Physical therapy beginning after 2-4 weeks, focusing on quadriceps strengthening and gait training
The non-operative approach is preferred for non-displaced fractures because it maintains the structural integrity of the knee joint, and the intact periosteum provides sufficient stability for healing without surgical intervention 1. However, if the fracture displaces during treatment or fails to heal, surgical intervention may become necessary.
From the Research
Treatment of Non-Displaced Tibial Plateau Fracture
- The treatment of non-displaced tibial plateau fractures can vary depending on the severity of the fracture and the patient's overall health 2, 3.
- Non-operative management may be considered for patients with minimally displaced fractures, with a gap or stepoff of less than 4 mm 4.
- However, surgical management may be necessary for more severe fractures, or for patients with associated soft tissue injuries or ligamentous instability 2, 5.
- The goal of treatment is to restore articular congruity, mechanical alignment, and ligamentous stability, and to permit early mobilization 2, 5.
Non-Operative Management
- Non-operative management may include immobilization, weight-bearing restrictions, and physical therapy 6.
- Early range of motion exercises and weight-bearing activities may be beneficial for patients with non-displaced fractures 6.
- However, the optimal rehabilitation protocol for non-displaced tibial plateau fractures is not well established, and further research is needed to determine the most effective treatment strategies 6.
Surgical Management
- Surgical management may include open reduction and internal fixation (ORIF), or minimally invasive osteosynthesis (EFMO) 5.
- The choice of surgical approach and technique will depend on the severity and location of the fracture, as well as the patient's overall health and medical history 5.
- Surgical management can help to restore articular congruity and mechanical alignment, and can reduce the risk of complications such as post-traumatic arthritis and ligamentous instability 2, 5.
Outcomes and Prognosis
- The outcomes and prognosis for patients with non-displaced tibial plateau fractures are generally good, with most patients achieving excellent functional results 2, 4.
- However, the risk of complications such as post-traumatic arthritis and ligamentous instability is higher for patients with more severe fractures, or for those who undergo surgical management 2, 5.
- Further research is needed to determine the optimal treatment strategies for non-displaced tibial plateau fractures, and to improve patient outcomes and prognosis 6, 4.