From the Guidelines
Management of a minimally depressed lateral tibial plateau fracture typically involves non-operative treatment with protected weight-bearing and early range of motion exercises. This approach is based on the principle that simple immobilization is appropriate when fracture fragments are small, nonarticular, or minimally displaced, as noted in the study by the American College of Foot and Ankle Surgeons 1. The key aspects of this management strategy include:
- Non-weight bearing for 6-8 weeks using crutches or a walker, followed by progressive weight-bearing as tolerated
- Use of a hinged knee brace for 6 weeks to provide stability while allowing controlled motion
- Pain management with acetaminophen and NSAIDs, reserving opioids for breakthrough pain
- Early initiation of physical therapy, focusing on gentle range of motion exercises and progressing to strengthening
- Regular follow-up with radiographs to monitor healing and ensure the depression doesn't worsen This conservative approach is suitable for minimally depressed fractures, which maintain adequate joint congruity and stability, allowing bone healing without surgical intervention, as implied by the study 1. However, close monitoring is essential, and surgical management may become necessary if the patient develops increasing pain, instability, or if follow-up imaging shows progression of depression.
From the Research
Management of Minimally Depressed Lateral Tibial Plateau Fracture
- The goal of managing minimally depressed lateral tibial plateau fractures is to achieve a stable, well-aligned, congruent joint with a painless range of motion and function 2.
- For minimally displaced stable fractures, protected mobilization is recommended 2.
- The treatment of displaced tibial plateau fractures requires careful evaluation of both the fracture and the soft-tissue envelope, with surgical reduction and stabilization indicated in certain cases 2.
- The anterolateral approach is a common approach for treating lateral tibial plateau fractures, allowing for visualization of the lateral joint, metaphysis, and shaft extension 3, 4.
- Techniques such as submeniscal arthrotomy, bone grafting, and buttress plating may be used to achieve a congruent joint surface and optimize treatment outcome 2, 3, 4.
- Arthroscopically assisted reduction and internal fixation (ARIF) has been shown to be a viable alternative to open reduction and internal fixation (ORIF), with some studies suggesting better clinical results with ARIF 5.
- The choice of treatment approach depends on the severity of the fracture, patient characteristics, and the presence of concomitant intra-articular lesions 5.
- Postoperative complications, such as infection and post-traumatic arthritis, can occur, and careful management is necessary to minimize these risks 6, 5.