Tibial Plateau Fracture

The tibia or shin bone is a long bone in the lower leg. Flat surfaces called medial and lateral tibial plateaus at the upper end of the tibia articulate with the femur (thigh bone) to form the knee joint. This surface is softer than the region of the tibia below. A force that drives the end of the femur into the soft tibial plateau leads to a tibial plateau fracture and can affect stability, and lead to arthritis and loss of motion.

Tibial plateau fractures may occur due to high-speed accidents, fall from a height, or low-impact stress or injury in a compromised bone due to cancer, infection or osteoporosis. The bone may fracture into one or many parts or compress under the force. There may be accompanying soft tissue injury with damage to nerve and blood vessels. The fracture site may be exposed as a result of bone rupturing through the skin (open fracture) which can lead to infection and delayed healing.

Symptoms of a tibial plateau fracture include pain, swelling, deformity, and inability to bear weight or bend the affected knee. There may be numbness or a pale appearance of the foot if neurovascular injury is present.

To diagnose a tibial plateau fracture, your doctor will review your medical history and perform a physical examination. Any soft tissue injuries are assessed along with nerve function and blood supply. X-rays or CT scans are ordered to identify the location and severity of the fracture. MRI scans may be ordered to assess injuries to soft tissue such as tendons and ligaments.

The elderly and those in whom surgery is not advised for medical reasons are treated with casting, bracing, limiting motion and weight bearing. Surgery is usually recommended in young active individuals and in those with open fractures as an emergency procedure. It involves making an incision, reducing the fractured bone, and stabilizing it with screws, plates and rods. Bone grafts and products that stimulate bone growth may be used. When there is extensive soft tissue injury, surgery is postponed until the tissue heals and the fracture is stabilized with an external fixator. Rehabilitation and physical therapy to prevent stiffness and improve range of motion and strength should start as soon as your soft tissues and fracture have healed. You will need to use crutches or a walker to move around.