From the Guidelines
For a tibial plateau grade one fracture, simple immobilization is the appropriate treatment when fracture fragments are small, nonarticular, or minimally displaced. This approach is based on the principle that minimal displacement and non-articular involvement allow for natural healing of the bone while preserving knee function 1. The diagnosis of a tibial plateau grade one fracture is typically made through a combination of clinical history, focal pain on palpation, and confirmation with radiographic studies.
Key considerations in the management of a tibial plateau grade one fracture include:
- Limited weight-bearing for a period to reduce stress on the fracture site
- Use of a hinged knee brace for stability
- Pain management with medications such as acetaminophen or NSAIDs, if not contraindicated
- Early initiation of physical therapy to maintain range of motion and strengthen the surrounding muscles
- Regular follow-up with orthopedic evaluation and X-rays to monitor the healing process
Given the nature of grade one fractures, conservative, non-surgical management is generally effective, allowing most patients to achieve full recovery within a few months 1. However, it is crucial to monitor for any signs of fracture displacement or increased pain, which would necessitate immediate medical reevaluation.
From the Research
Overview of Tibial Plateau Fractures
- Tibial plateau fractures are peri-articular knee fractures of the proximal tibia, with varying presentations depending on the mechanism of injury 2.
- The tibial plateau is composed of a medial and lateral condyle separated by the intercondylar eminence, and its fractures can be 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 to permit early mobilization 2, 4.
- The goal of management is to achieve a stable anatomic reduction, with a tailored approach to the individual patient taking into account factors such as injury pattern, host type, surgical skills, and local availability of implant devices 4.
Rehabilitation and Outcomes
- Early range of motion exercises and early weight-bearing are recommended for patients with tibial plateau fractures 5.
- Ongoing rehabilitation with a focus on quadriceps strengthening and proprioception exercises is also recommended to improve clinical outcomes 5.
- The medium-term functional outcome after tibial plateau fractures is generally excellent when anatomy and stability are restored, with at least half of patients returning to their original level of physical activity 2.
Challenges and Controversies
- There is a lack of consensus on the management of tibial plateau fractures, with various operative techniques and management strategies reported in the literature 3, 4.
- The literature on physiotherapy after tibial plateau fracture fixation is scarce and controversial, highlighting the need for further research in this area 5, 6.