From the Research
Treatment Overview
The treatment for a tibial plateau fracture can vary depending on the severity of the fracture, but generally includes:
- Conservative management for less severe fractures
- Surgical management for more severe fractures to restore articular congruity, mechanical alignment, ligamentous stability, and to permit early mobilization 1
- The goal of treatment is to achieve precise reconstruction of the articular surfaces, stable fragment fixation allowing early motion, and repair of all concomitant lesions 2
Surgical Management
Surgical management is required for more severe tibial plateau fractures, and may involve:
- Open reduction and internal fixation (ORIF) to restore the articular surface and stabilize the fracture 2
- The use of a stepwise approach in complex knee trauma, including primary treatment with closed reduction, wound debridement, and external fixation, followed by open reduction and internal fixation and complex bone and soft-tissue reconstructions in a second operation 2
- The application of an updated Three-Column Concept to guide surgical treatment, which assesses fracture morphology and injury mechanism in tandem 3
Classification and Diagnosis
The classification and diagnosis of tibial plateau fractures is crucial for determining the appropriate treatment, and may involve:
- The use of the Schatzker classification system to classify the fracture 1, 4
- The assessment of fracture morphology, ligamentous and neurovascular injuries, and diagnostic and therapeutic options 5
- The use of imaging studies, such as X-rays and CT scans, to evaluate the fracture and determine the best course of treatment 3
Expected Outcomes
The expected outcomes for tibial plateau fractures can vary depending on the severity of the fracture and the effectiveness of treatment, but generally include:
- Good functional outcomes, with at least half of patients returning to their original level of physical activity 1
- A tolerable complication rate, with potential complications including postoperative arthritis, bicondylar and comminuted fractures, meniscal removal, instability, malalignment, and articular incongruity 1, 4
- Successful application of biologically friendly fixation constructs, with limited fixation failure and associated complications 3