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Tibial Plateau Fractures Workup

  • Author: Srinivasa Vidyadhara, MBBS, MS, DNB; Chief Editor: Thomas M DeBerardino, MD  more...
 
Updated: Aug 27, 2015
 

Imaging Studies

For a discussion of the challenges in radiologic diagnosis and evaluation of tibial plateau fractures, see Dennan.[11]

Radiography

Most tibial plateau fractures are easy to identify on standard anteroposterior (AP) and lateral projections of the knee. Lateral views should not be considered adequate if a rotational component obscures the visualization of the femoral condyles as a single unit. Rotational malalignment can lead to missed zones of injury and an inaccurate estimation of the degree of articular depression.

With minimally displaced vertical split fractures, the fracture line often lies in an oblique plane and is therefore not visible on an AP or lateral radiograph. Oblique projections should be added if a nondisplaced tibial plateau fracture is suspected but not seen on the standard projections.

The following subtle radiologic signs may indicate the presence of an underlying plateau fracture:

  • Lipohemarthrosis - The presence of a fat/fluid level in the suprapatellar recess on the horizontal-beam lateral projection of the knee indicates that a fracture has occurred and has allowed fatty marrow to enter the joint
  • Increased trabecular density beneath the lateral plateau on an AP film - The medial tibial condyle normally has greater trabecular density because it bears more body weight
  • Nonalignment of the femoral condyles and tibia on the AP view

An AP projection of the knee, angled 15° caudally (tibial plateau view), can provide a more accurate assessment of the depth of plateau surface depression.

Traction radiographs provide a clearer image of the fracture configuration after anatomic alignment is restored. Areas of bone loss resulting from comminution can be mapped, and the appropriate size and length of the necessary implants can be ascertained.

Corresponding views of the uninjured knee and extremity are necessary for each patient to receive accurate restoration of length and alignment of the leg.

Computed tomography

By acquiring thin axial slices through the knee and reconstructing the image data in the sagittal and coronal planes, computed tomography (CT) provides more detailed information. The information obtained from a CT scan can help determine the best surgical approach based on the fracture planes seen on the computer images. Three-dimensional spiral CT reconstructions yield a better and more accurate demonstration of the tibial plateau fracture. They present the anatomy in the view the surgeon will see when surgery is performed.

Magnetic resonance imaging

Magnetic resonance imaging (MRI) is acknowledged as a reliable and accurate tool for assessing meniscal, collateral, and cruciate ligamentous injury,[12] as well as for identifying occult fractures of the tibial plateau.

A bone bruise is indicated by epiphyseal and metaphyseal changes in T1- and T2-weighted images. The signals indicate normal articular and cortical bone changes and reflect changes in bone marrow. They are thought to represent edema, hyperemia, hemorrhage, and microfracture. Plateau fractures may be visualized on MRIs, even when plain film radiographs are normal.

A major advantage that MRI has over CT is that MRI does not use ionizing radiation. Disadvantages include the higher cost and greater time needed to complete the study (25 minutes for MRI vs 20 seconds for CT), which means that motion artifact can be a problem.

 
 
Contributor Information and Disclosures
Author

Srinivasa Vidyadhara, MBBS, MS, DNB MS(Ortho), DNB(Ortho), FNB(Spine Surgery), MNAMS, Consultant, Department of Spine Surgery, Manipal Hospital, India

Srinivasa Vidyadhara, MBBS, MS, DNB is a member of the following medical societies: AO Foundation, Scoliosis Research Society

Disclosure: Nothing to disclose.

Coauthor(s)

Mundkur Sudhakar Shetty, MBBS, MS, MCh Senior Professor and Head of Orthopedic Department, Yenapoya Medical College and Hospitals, Mangalore

Mundkur Sudhakar Shetty, MBBS, MS, MCh is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Sharath K Rao, MBBS, MS, D'Ortho Professor and Head of Unit V, Department of Orthopedics, Kasturba Medical College Hospital, India

Sharath K Rao, MBBS, MS, D'Ortho is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Indian Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Thomas M DeBerardino, MD Associate Professor, Department of Orthopedic Surgery, Consulting Surgeon, Sports Medicine, Arthroscopy and Reconstruction of the Knee, Hip and Shoulder, Team Physician, Orthopedic Consultant to UConn Department of Athletics, University of Connecticut Health Center

Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Arthrex, Inc.; Ivy Sports Medicine; MTF; Aesculap; The Foundry, Cotera; ABMT<br/>Received research grant from: Histogenics; Cotera; Arthrex.

Additional Contributors

Phillip J Marone, MD, MSPH Clinical Professor, Department of Orthopedic Surgery and Department of Rehabilitation Medicine, Jefferson Medical College of Thomas Jefferson University

Phillip J Marone, MD, MSPH is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Medical Association, American Orthopaedic Society for Sports Medicine, Philadelphia County Medical Society

Disclosure: Nothing to disclose.

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Type II tibial plateau fracture in a young active adult with good bone stock treated with percutaneous elevation and cannulated cancellous screw fixation without bone grafting.
Type III tibial plateau fracture with central depression in an elderly person treated surgically using percutaneous elevation, bone grafting, and cancellous screw fixation.
Type VI tibial plateau fracture undergoing biological fixation of the lateral condyle and external fixation of the medial plateau, resulting in an acceptable clinical and radiological result.
Type II tibial condyle fracture involving the tibial spine and more than 50% of the medial condyle fixed with biological buttress plating of the lateral plateau.
Type VI tibial plateau fracture with severe soft tissue injury successfully treated with Ilizarov external ring fixator.
High-energy type VI tibial plateau fracture treated with bone grafting and double plating after the soft tissue condition improved.
Type IV medial tibial condyle fracture treated with arthroscopy-assisted elevation and percutaneous cancellous screw fixation along with percutaneous screw fixation of the tibial spine fracture.
Shown is an intra-articular fracture of the medial condyle of the tibial plateau.
Shown is a Schatzker type V fracture, with a displaced and depressed medial tibial plateau.
 
 
 
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