What are Tibial Plateau Fractures?

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What is a Tibia?

The shin bone is also known as the tibia and forms part of the knee joint. This part of the tibia is also known as the tibia plateau. As part of the knee joint, the tibial plateau helps to support your body weight and allows the knee to bend and straighten.

Tibial Plateau Fractures happen when an injury causes the bone to break. This is a serious injury and is often accompanied by soft tissue injuries to the ligaments, menisci, muscles, blood vessels, nerves, and skin in the vicinity of the knee.

What can cause a tibial plateau fracture?

Tibial Plateau Fractures usually occur from high-energy direct or indirect injuries to the knee. An example of a direct injury is a gunshot wound to the knee. Indirect injuries refer to injuries sustained when the force exerted is away from the site of the fracture. An example would be a fracture sustained from a twisting injury to the knee, which is common during sport. In some patients with low bone density, minor injuries such as slips or falls from a low height can also cause the tibial plateau to fracture.

What symptoms will I have?

Patients who have sustained a tibial plateau fracture usually complain of severe pain around the knee. The knee will also be swollen, with patients unable to bend or move the affected knee. Most patients will also find it difficult to stand, much less walk on the affected leg.

In some patients, there can be severe pain in the calf region as well. This is an important symptom of a condition known as compartment syndrome, which is a complication known to occur after a tibial plateau fracture.

If you have any of the above symptoms after an injury, please seek medical help as soon as possible.

How is a tibial plateau fracture diagnosed?

Your doctor will first conduct a medical interview, where he/she will ask about the injury that occurred, and the ensuing symptoms. He/she will then conduct a focused medical examination on the affected limb, to assess for the skin condition and blood circulation of the affected leg. A general medical examination may also be conducted to rule out injuries in other parts of the body.

Plain X-rays of the knee are usually sufficient to diagnose a tibial plateau fracture. In most patients, a computerised tomographic (CT) scan will also be ordered to better understand the fracture configuration. This is especially helpful for patients who need to undergo surgery to repair the damaged bone.

How are tibial plateau fractures treated?

In general, most patients who have sustained a tibial plateau fracture will require surgery. This is because the tibial plateau is a very important part of the knee joint. If damage to the tibial plateau is not repaired, patients will frequently suffer from knee pain with even minimal physical activity. In addition, a damaged tibial plateau greatly increases the risk of subsequent knee osteoarthritis.

In some patients with undisplaced tibial plateau fractures, the doctor may elect to manage the fracture with non-surgical methods. This usually involves placing the affected leg in an above knee cast. This cast will typically be worn for 6 to 8 weeks, with the knee held in extension (straight). If the fracture has healed sufficiently, the patient is frequently referred for knee physiotherapy subsequently.

Surgical Treatment

The mainstay of treatment for tibial plateau fractures is surgery. Depending on the fracture pattern, as well as the state of the surrounding soft tissues, the methods used for the treatment of this condition can include,

  1. Open Reduction and internal fixation refer to the technique whereby the skin around the fracture site is cut to reveal the broken bones. These bones are then put back in place, and held in place by the use of metal plates and screws. This allows the bones to heal in a good position, minimising the risk of osteoarthritis.

Recovery and Rehabilitation

After a Tibial Plateau Fracture surgery, rehabilitation is an important step to ensure that the patient recovers range of knee motion, and regains the ability to climb stairs, walk long distances and participate in sport or exercise.

Patients who have undergone surgery, will usually be referred for physiotherapy after a short period of rest. During the initial phase, they may also be required to use crutches to prevent too much weight being borne on the injured leg.

If patients adhere to the physiotherapy regime prescribed, most patients will be able to return to sport within 3 to 6 months after a tibial plateau fracture.

For assessment of your condition, please book an appointment with Dr Yong Ren.

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Sarah Taylor

Obstetrics & Gynaecology