Tibial plateau fractures are rare, making up around 1% of all fracture injuries. Tibial plateau fractures usually result from severe trauma. But these fractures can also happen when you have weakened or compromised bone density.
The tibial plateau is a bone more commonly known as the shin bone. It's located at the top of your tibia bone, the bone that connects your knee and ankle. The tibial plateau is flat and made up of cartilage. Its smooth surface helps your knees to work.
Vehicular accidents are the leading cause of tibial plateau fractures, but falls and sport-related injuries can also contribute to a tibial plateau fracture. People over 50 are more susceptible to sustaining a fracture to their tibial plateau. Still, it can affect people of all ages.
Tibial plateau fractures happen when there is a break in the shin bone or tibia. The severity of this fracture can vary, but, for the most part, this type of fracture is a severe injury, especially since the shin bone is critical to the knee's operation.
There are two types of tibial plateau fractures: nondisplaced and displaced.
Nondisplaced Tibial Plateau Fracture
Nondisplaced tibial plateau fractures are less severe than displaced ones and generally offer a better outcome. These fractures happen when the shin bone breaks or cracks, but the bone doesn't separate.
Typically, these fractures heal independently within a few months and don’t require surgery. But you need to use caution during your recovery period and make sure that you get enough rest, keep weight off the affected leg, and protect the knee with a brace.
Patients with nondisplaced fractures should also get rehabilitation. Specific exercises will help you maintain leg strength.
Displaced Tibial Plateau Fracture
Displaced fractures are severe injuries where the tibia bone breaks. The bone can split into two or several fragments. Most patients need surgery, in the form of adding screws or plates around the broken bone, to repair the bone and promote the healing of the affected tissue.
The recovery time for a displaced fracture is generally longer than for a nondisplaced fracture, spanning several months. During this time, you shouldn't put weight or strain on your affected leg.
Tibial Plateau Fracture Symptoms
A tibial plateau fracture has a few noticeable symptoms, like:
- A recent knee trauma
- Pain ranging in severity from mild to severe
- Swelling of the knee joint
- Inability to bear weight
- Knee joint stiffness
Diagnosing Tibial Plateau Fractures
If you have knee pain or recent knee trauma, edema, or deformities, you should consult your doctor to evaluate possible causes.
Your doctor may perform a complete physical examination. During this time, your doctor will examine the affected knee and compare it to the uninjured knee.
The doctor will pay close attention to the skin and knee effusion during the evaluation. Additionally, they may perform a neurovascular exam to test sensations, motor function, and range of motion. They may perform other tests as well.
Schatzker Classification
One method to describe a fracture’s impact and pain level is called the Schatzker classification. This classification is divided into six types:
- Type I: The less severe fracture type and the one with the best outcome. These fractures happen when there is a displaced or wedge fracture in the lateral plateau.
- Type II: Type II is a split compression fracture. Injuries to the ligaments and meniscus often accompany type II. Individuals with poor bone quality are at increased risk of a type II fracture.
- Type III: Patients with osteoporosis are more susceptible to a type III fracture. This fracture type happens when the lateral plateau is affected by central or peripheral components. Unlike the previous two types, a type III fracture does not have a wedge fracture.
- Type IV: Type IV often happens alongside a soft tissue injury, resulting in the medial tibial plateau breaking into fragments. Peroneal nerve traction and popliteal artery injury can also happen with type IV. This type of fracture has the worst outlook.
- Type V: A type V tibial plateau fracture happens when both the lateral and medial tibial plateau are affected, typically in a split bicondylar fracture.
- Type VI: Type VI fractures are bicondylar. The diaphysis, the long part of the bone, and metaphysis, the neck of the long bone, are typically separated in this fracture. Soft tissue injuries may result.
Tibial Plateau Fracture Treatment
A tibial plateau fracture is painful and may prevent you from walking. Many patients require immediate medical attention due to the pain and find themselves in the emergency room. During your visit, a doctor will take pictures of your affected knee using X-rays and a CT scan. If the fracture is mild and doesn't involve fragmented bones, you may be able to return home with a brace or splint. Severe fractures almost always require surgical intervention and a hospital stay. But some mild fractures may require you to stay at the hospital for observation.
If the fracture is severe and you need tibial plateau surgery, the doctor will insert a temporary external fixator, an instrument consisting of pins and bars, into your knee. Once the swelling has gone away, they can replace the external fixator with plates and screws to promote further healing.
Tibial Plateau Fracture Recovery
Recovery depends on the severity of your fracture. In almost all cases, patients with a fracture must rest their affected knee between 6 and 12 weeks. Resting your knee means that you will not be able to put weight on it, and, in some cases, you may be unable to walk. Crutches, walkers, and wheelchairs can ease the burden of your inability to move. Additionally, you’ll need to practice gentle exercises involving your knee, ankle, and hip.
Like most injuries, a tibial plateau fracture can result in arthritis developing later. Symptoms can range from mild to severe and are usually related to pain, stiffness, weakness, and swelling. It may be difficult or impossible to exercise, run, or even climb stairs. In severe cases, knee replacement surgery is an option.