Tibial Plateau Fractures Workup

  • Author: S Vidyadhara, MBBS, MD, MS(Ortho), DNB(Ortho), FNB(Spine Surgery), MNAMS; Chief Editor: Carlos J Lavernia, MD, FAAOS   more...
 
Updated: Feb 10, 2012
 

Imaging Studies

  • Anteroposterior (AP), lateral, and oblique radiographs
    • Most tibial plateau fractures are easy to identify on standard 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 one 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.
  • Tibial plateau radiograph: 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: These images 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.
  • Contralateral knee/extremity radiographs: Corresponding views of the uninjured leg are necessary for each patient to receive accurate restoration of length and alignment of the leg.
  • CT scan: By acquiring thin axial slices through the knee and reconstructing the image data in the sagittal and coronal planes, more detailed information is provided. 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 images
    • MRI is acknowledged as a reliable and accurate tool to assess meniscal, collateral, and cruciate ligamentous injury.[12] Also, occult fractures of the tibial plateau can be identified by MRI. 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 of MRI over CT scanning is that MRI does not use ionizing radiation. Disadvantages include the higher cost and greater time needed to complete the study (25 min for MRI vs 20 sec for a CT scan), which means that motion artifact can be a problem.

For a discussion of the challenges in radiological diagnosis and evaluation of tibial plateau fractures, see Dennan.[13]

Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

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

S Vidyadhara, MBBS, MD, MS(Ortho), DNB(Ortho), FNB(Spine Surgery), MNAMS is a member of the following medical societies: AO Foundation and Scoliosis Research Society

Disclosure: Nothing to disclose.

Coauthor(s)

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 and Indian Medical Association

Disclosure: Nothing to disclose.

Mundkur Sudhakar Shetty, MBBS, MS, MCh  Senior Professor and Head 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.

Specialty Editor Board

Phillip J Marone, MD, MSPH  Clinical Professor, Department of Orthopedic Surgery, Jefferson Medical College

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, and Philadelphia County Medical Society

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

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, and American Orthopaedic Society for Sports Medicine

Disclosure: Arthrex, Inc. Grant/research funds Other; Arthrex, Inc. Consulting fee Speaking and teaching; Genzyme Biosurgery. Inc. Grant/research funds Other; Musculoskeletal Transplant Foundation Grant/research funds Other; Histogenics Grant/research funds None

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Carlos J Lavernia, MD, FAAOS  Adjunct Clinical Professor, Department of Orthopedic Surgery, University of Miami School of Medicine; Medical Director, Orthopedic Institute at Mercy Hospital

Carlos J Lavernia, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, Arthritis Foundation, Biomedical Engineering Society, Florida Orthopaedic Society, and Orthopaedic Research Society

Disclosure: Zimmer Stock Implant Designer

References

  1. Agnew SG. Tibial plateau fractures. Oper Tech Orthoped. 1999;9(3):197-205.

  2. Burrows HJ. Fractures of the lateral condyle of the tibia. J Bone Joint Surg Br. Aug 1956;38-B(3):612-3. [Medline].

  3. Rasmussen PS. Tibial condylar fractures. Impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg Am. Oct 1973;55(7):1331-50. [Medline].

  4. Sarmiento A. Functional bracing of tibial and femoral shaft fractures. Clin Orthop Relat Res. Jan-Feb 1972;82:2-13. [Medline].

  5. Maripuri SN, Rao P, Manoj-Thomas A, Mohanty K. The classification systems for tibial plateau fractures: how reliable are they?. Injury. Oct 2008;39(10):1216-21. [Medline].

  6. Hohl M, Luck JV. Fractures of the tibial condyle; a clinical and experimental study. J Bone Joint Surg Am. Oct 1956;38-A(5):1001-18. [Medline].

  7. Hohl M. Tibial condylar fractures. J Bone Joint Surg Am. Oct 1967;49(7):1455-67. [Medline].

  8. Moore TM. Fracture--dislocation of the knee. Clin Orthop Relat Res. May 1981;(156):128-40. [Medline].

  9. Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968--1975. Clin Orthop Relat Res. Jan-Feb 1979;(138):94-104. [Medline].

  10. Weaver MJ, Harris MB, Strom AC, Smith RM, Lhowe D, Zurakowski D, et al. Fracture pattern and fixation type related to loss of reduction in bicondylar tibial plateau fractures. Injury. Dec 9 2011;[Medline].

  11. Pernaa K, Koski I, Mattila K, Gullichsen E, Heikkila J, Aho A, et al. Bioactive Glass S53P4 and Autograft Bone in Treatment of Depressed Tibial Plateau Fractures - A Prospective Randomized 11-year Follow-Up. J Long Term Eff Med Implants. 2011;21(2):139-48. [Medline].

  12. Mustonen AO, Koivikko MP, Lindahl J, Koskinen SK. MRI of acute meniscal injury associated with tibial plateau fractures: prevalence, type, and location. AJR Am J Roentgenol. Oct 2008;191(4):1002-9. [Medline].

  13. Dennan S. Difficulties in the radiological diagnosis and evaluation of tibial plateau fractures. Radiography. 2004;10:151-8.

  14. Laible C, Earl-Royal E, Davidovitch R, Walsh M, Egol KA. Infection after spanning external fixation for high-energy tibial plateau fractures: is pin site-plate overlap a problem?. J Orthop Trauma. Feb 2012;26(2):92-7. [Medline].

  15. Lubowitz JH, Elson WS, Guttmann D. Part I: Arthroscopic management of tibial plateau fractures. Arthroscopy. Dec 2004;20(10):1063-70. [Medline].

  16. Lubowitz JH, Elson WS, Guttmann D. Part II: arthroscopic treatment of tibial plateau fractures: intercondylar eminence avulsion fractures. Arthroscopy. Jan 2005;21(1):86-92. [Medline].

  17. Kayali C, Oztürk H, Altay T, Reisoglu A, Agus H. Arthroscopically assisted percutaneous osteosynthesis of lateral tibial plateau fractures. Can J Surg. Oct 2008;51(5):378-82. [Medline].

  18. Kumar P, Singh GK, Bajracharya S. Treatment of grade IIIB opens tibial fracture by ilizarov hybrid external fixator. Kathmandu Univ Med J (KUMJ). Apr-Jun 2007;5(2):177-80. [Medline].

  19. Krappinger D, Struve P, Smekal V, Huber B. Severely comminuted bicondylar tibial plateau fractures in geriatric patients: a report of 2 cases treated with open reduction and postoperative external fixation. J Orthop Trauma. Oct 2008;22(9):652-7. [Medline].

  20. Yu B, Han K, Ma H, Zhang C, Su J, Zhao J, et al. Treatment of tibial plateau fractures with high strength injectable calcium sulphate. Int Orthop. Aug 13 2008;[Medline].

  21. Lasanianos N, Mouzopoulos G, Garnavos C. The use of freeze-dried cancelous allograft in the management of impacted tibial plateau fractures. Injury. Oct 2008;39(10):1106-12. [Medline].

  22. Russell TA, Leighton RK. Comparison of autogenous bone graft and endothermic calcium phosphate cement for defect augmentation in tibial plateau fractures. A multicenter, prospective, randomized study. J Bone Joint Surg Am. Oct 2008;90(10):2057-61. [Medline].

  23. Duan XJ, Yang L, Guo L, Chen GX, Dai G. Arthroscopically assisted treatment for Schatzker type I-V tibial plateau fractures. Chin J Traumatol. Oct 2008;11(5):288-92. [Medline].

  24. Mills WJ, Barei DP. High-energy tibial plateau fractures: Staged management. Oper Tech Orthoped. 2003;13(2):96-103.

  25. Chan YS, Chiu CH, Lo YP, Chen AC, Hsu KY, Wang CJ, et al. Arthroscopy-assisted surgery for tibial plateau fractures: 2- to 10-year follow-up results. Arthroscopy. Jul 2008;24(7):760-8. [Medline].

  26. Rossi R, Bonasia DE, Blonna D, Assom M, Castoldi F. Prospective follow-up of a simple arthroscopic-assisted technique for lateral tibial plateau fractures: results at 5 years. Knee. Oct 2008;15(5):378-83. [Medline].

  27. Papagelopoulos PJ, Partsinevelos AA, Themistocleous GS, et al. Complications after tibia plateau fracture surgery. Injury. Jun 2006;37(6):475-84. [Medline].

  28. Mehin R, O'Brien P, Broekhuyse H, Blachut P, Guy P. Endstage arthritis following tibia plateau fractures: average 10-year follow up. Can J Surg. Feb 1 2012;55(1):003111-3111. [Medline].

 
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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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