Tibial plateau fracture

Background

Anatomy of anterolateral aspect of right knee.

• ACL and MCL injuries associated with lateral plateau fracture
• PCL and LCL associated with medial plateau fracture
• Compartment syndrome may occur
• Segond fracture
  • Avulsion fracture of margin of lateral tibial plateau just below joint line
  • Associated with tear of ACL and meniscal ligaments

Clinical Features

• Occurs via axial load that drives femoral condyle into tibia

Differential Diagnosis

Knee diagnoses

Acute knee injury

• Knee dislocation
• Knee fractures
  • Patella fracture
  • Segond fracture
  • Tibial plateau fracture
• Meniscus and ligament knee injuries
• Patella dislocation
• Patellar tendonitis
• Patellar tendon rupture
• Quadriceps tendon rupture

Nontraumatic/Subacute

• Arthritis
• Gout and Pseudogout
• Osgood-Schlatter disease
• Patellofemoral syndrome (Runner's Knee)
• Patellar tendonitis (Jumper's knee)
• Pes anserine bursitis
• Popliteal cyst (Bakers cyst)
• Prepatellar bursitis (nonseptic)
• Septic bursitis
• Septic joint
• DVT

Distal Leg Fracture Types

• Tibial plateau fracture
• Tibial shaft fracture
• Pilon fracture
• Maisonneuve fracture
• Tibia fracture (peds)
• Ankle fracture
  • Ankle fracture (peds)
    • Tillaux fracture
• Foot and toe fractures

Evaluation

Schatzker Classification of Tibial Plateau Fractures

Imaging

Lipohemarthrosis (presence of fat and blood from bone marrow in the joint space after an intraarticular fracture) seen on X-ray in a person with a subtle tibial plateau fracture

• AP, lateral, oblique views (internal for lateral plateau, external for medial plateau). Tunnel view may also be helpful.
  • AP - line drawn at lateral margin of femur should not have >5mm of tibia beyond it
• CT or MRI should be considered if plain film negative but high clinical suspicion based on mechanism or inability to bear weight

Schatzker Classification

• Schatzker I Lateral split
• Schatzker II Split with depression
• Schatzker III Pure lateral depression
• Schatzker IV Pure medial depression
• Schatzker V Bicondylar
• Schatzker VI Split extends to metadiaphysis

Management

General Fracture Management

• Acute pain management
• Open fractures require immediate IV antibiotics and urgent surgical washout
• Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
• Consider risk for compartment syndrome

Specific Management

• Knee immobilizer with non-weightbearing and ortho referral in 2-7d
• Emergent surgical management if open or if neurovascular compromise

Disposition

• Outpatient follow up

Indications for Expedited Referral (within 48hr)

• Significant displacement or depression
• Suspected or documented ligamentous injury

Indications for (outpatient) surgery

• Articular stepoff > 3mm
• Condylar widening > 5mm
• Varus/valgus instability
• All medial plateau fractures
• All bicondylar fractures

See Also

• Fractures (Main)
• Knee (Main)