Tibial Plateau Fracture

Aetiology

  • Higher energy injuries in the young
  • Low energy injuries in older osteoporotic bone
  • 80% affect lateral condyle, following valgus force with foot planted ('bumper injury')

Pathophysiology

Schatzer classification

notion image

Clinical presentation

  • Pain and instability

Investigations

  • X-ray - AP and horizonal beam lateral
    • Variable appearance, from obvious fracture line to subtle subchondral sclerosis
    • Horizontal beam lateral shows lipohaemarthrosis - fat floating on blood in the suprapatellar recess, a specific sign of an intra-articular fracture
    • Small avulsed bone fragments sometimes indicates significant soft tissue injury
  • CT shows area of condylar involvement/depth of depression which guides treatment

Management

  • Conservative - above knee cast
  • Operative - ORIF, external fixator, delayed TKR

Complications

  • Blow to lateral aspect of knee (described as a 'bumper injury' when a pedestrian is struck by a car) can damage the common fibular nerve
  • Associated risk of neurovascular injury of popliteal structures
  • High risk of compartment syndrome
  • Associated soft tissue injuries of knee joint structures