Tibial Plateau Fracture

What is it?

The tibial plateau is where the shinbone is supported and also where the cruciate ligaments attach. The tibial plateau has two sides; one being the medial which is larger, more flat, and concave, and the other being the lateral tibia plateau, which is smaller and convex. Both elements combine to help evenly distribute force through the shinbone. 

How does it get hurt/damaged?

A fracture to the tibial plateau surface can be caused in a variety of different ways. Often patients will experience a fracture due to a fall from a great height, a motor vehicle crash, or even an injury while snowboarding.

Tibial plateau fractures come in a few shapes and sizes. The first is a Humpty Dumpty fracture. This fracture has very small and fragmented pieces which means it can be hard to put them back together, and can cause a patient to develop traumatic arthritis.

The next two are displaced and non-displaced fractures. In a non-displaced fracture, the fracture occurs without the bone breaking into multiple pieces. This fracture generally doesn’t have an affect on the cartilage, and if healed correctly, will result in little consequence. A displaced fracture, however, is a different story, and will cause larger issues down the road. In a displaced fracture, the bone fully breaks off and will have to have fixation hardware used to set it into a healing position.

How common is a tibial plateau fracture?

Tibial plateau fractures are common as there can be many causes of this injury. Roughly 35,000 people in the United States every year sustain this injury.

When should you be worried about a tibial plateau fracture? What should you do initially?

Tibial plateau fractures are high energy injuries, which means that urgent and emergency fractures need to be seen immediately as they can cause longer withstanding issues for the patient. An x-ray will determine if the plateau fracture has resulted in a step off at the joint, but if the x-rays aren’t clear, then there will need to be a CT scan done. 

What is the severity of the injury and the treatment options?

Similarly to the initial response to a tibial plateau fracture, the treatment and severity of fractures is based upon the type of a patient received. X-rays will almost always be done to understand the severity of a fracture, but often a CT scan will also be required to get a better understanding of where the fracture fragments may be offset. An MRI scan may also be done to understand how the supporting cast around the fracture (menisci, cruciate ligaments, and other ligaments) have been affected.

Humpty Dumpty fractures will depend on the amount of displacement of the fracture and how extensive the fracture is, in order to determine whether or not a patient will require surgery. Nondisplaced fractures can usually be treated with a period immobilization and/or non-weight bearing activity. They usually have little to no offset of the cartilage surface and can heal properly, under the right circumstances. Displaced fractures can cause significant issues and will require surgery as the next step. In cases where the fractures contains a surface with just a little bit of fragmentation, the joint surface can usually be fixed. With significant fragmentation, there is potential that a full repair will be incredibly difficult. Long term prognosis after a repair of this magnitude can be grim because the affected area can often develop arthritis.

What is my recovery timeline and the anticipated outcome?

When looking for a surgeon or looking towards your recovery timeline, seek out a surgeon who has a history of successful past procedures. If a first procedure goes awry, it is incredibly tough to try to fix it at a later point. After surgery, patients will need to be on crutches and non-weight bearing for six weeks or longer. Motion will often be allowed and even encouraged by your health care provider.

For both patients with a displaced and a non-displaced, physical therapy can be incredibly beneficial. Patients with a non-displaced injury will also need to undergo a period of time with no motion or weight put on the injured leg. Usually, the lesser the fracture, the better the outcome. Patients with a Humpty Dumpty-like fracture will often not be able to return to full activity and can become candidates for a total knee replacement.