Tibial Plateau Fracture

What is a tibial plateau fracture?

The tibial plateau is the upper part of the tibia that forms a part of the knee joint. It serves to transmit the load of the body across the knee joint. A fracture of the tibial plateau will extend into the knee joint and involve the cartilage surface within the knee joint. These fractures vary in severity, with some high-energy injuries having multiple fracture fragments.

What are the symptoms of a tibial plateau fracture?

The symptoms of a tibial plateau fracture are knee pain, swelling, and a restriction of movement after a traumatic event. Occasionally, certain types of tibial plateau fracture are a result of a knee dislocation and may affect the large vessels at the back of the knee.

How do you treat a tibial plateau fracture?

Fracture severity will usually be assessed with an X-ray and a CT scan of the knee. The CT scan will show how many fracture fragments there are and how much the fracture has moved from its normal position.

A large number of tibial plateau fractures can be treated non-operatively and may require a period of non-weight bearing (with crutches or a frame) and a brace.

Sometimes the characteristics of the fracture pattern shown on X-rays and CT scans are such that surgery is recommended. If a tibial plateau fracture has moved away significantly from its normal position and has healed this way, it may increase the risk of arthritis within the joint. Surgery aims to reduce the “gap” or “step” within the joint surface due to the fracture. Once the fracture is put back into place, it is held there with a plate and/or screws, allowing the fracture to heal in the correct position.

What does surgery for a tibial plateau fracture involve?

With severe tibial plateau fractures where the knee joint is unstable, an external frame may be placed across the knee to stabilise the knee joint and allow the swelling to settle for more definitive surgery. 

In most cases, the fracture can be definitively fixed without the need for a frame. This may require one to three open incisions depending on the fracture pattern. In all situations, the fracture pieces are placed back into their normal position and held there with a plate and/or screws. Occasionally, there are other internal knee injuries such as damage to the ligaments or meniscus within the knee. This can sometimes be fixed at the same time as the fracture, but will sometimes need to be staged.

What is the recovery following surgery for a tibial plateau fracture?

You will usually stay in hospital for 1-2 days after this operation. The surgical wounds will take 2 weeks to heal. 

Most patients will require approximately 6 weeks of non-weight bearing in order to allow the fracture to heal. In some cases, a brace will be required post-operatively. 

A referral to a physiotherapist will be made in order to help regain the range of motion and strength within the joint. Overall, recovery can take as long as 4-6 months.

Sometimes the plates used for fixing the fracture can be prominent and cause irritation. Provided the fracture has healed, the plates may need to be removed in the long term, approximately 1 year after the initial operation.