Typically, Dr. Bryan Penalosa will present to you the surgical option of a tibial plateau open reduction and internal fixation (ORIF). In some cases, this may be able to be completed arthroscopically. An ORIF involves making an incision to access the fracture site, repositioning the bone fragments into their normal alignment, and then using screws and a plate to hold the bones in place during the healing process. It will take 6-8 weeks for the bone to heal following an ORIF.
Knee
Tibial Plateau Fracture
There are three bones that make up the knee joint – the femur (thigh bone), the tibia (shin bone), and the patella (kneecap). The tibial plateau is the flat, top surface of the tibia that forms the bottom part of the knee joint. The tibial plateau is an important weight-bearing area of the knee joint that plays a key role in the stability and overall function of the joint.
What is a tibial plateau fracture?
A tibial plateau fracture is a type of injury that involves the upper part of the tibia known as the plateau. When a force, often from high-energy impacts like falls, car accidents, or sports injuries, is applied to the knee, it can cause the tibial plateau to break. The fracture can vary in severity, ranging from hairline cracks to more complex breaks that may involve displacement of the bone. Injuries to the tibial plateau can affect the stability and function of the knee joint.
What causes a tibial plateau fracture?
Tibial plateau fractures account for 1% of all fractures and are typically sustained with high-energy forces applied to the knee.
- Falls: Falling from a height or slipping and landing on the knee can transmit a significant force to the tibial plateau, leading to fractures.
- Sports Injuries: Participating in high-impact sports, such as skiing, football, or soccer, where there is a risk of falls or collisions, can increase the likelihood of tibial plateau fractures.
- Direct Blows to the Knee: Direct blows to the knee, such as those experienced in contact sports or car/motorcycle accidents, can cause fractures by exerting excessive force on the tibial plateau.
- Axial Loading: This occurs when a vertical force is applied to the leg, often in a situation where the foot is planted, and the body weight comes down onto the knee. This can happen in activities like jumping or landing from a height.
What are the symptoms of a tibial plateau fracture?
The symptoms of a tibial plateau fracture can vary depending on the severity of the injury, but common signs and symptoms include:
- Pain: Pain around the knee is a primary symptom. The intensity of the pain may vary, but it is typically aggravated by movement or putting weight on the affected leg.
- Swelling: Swelling around the knee joint is a common response to the injury. The extent of swelling may depend on the severity of the fracture.
- Bruising: Bruising (ecchymosis) may develop around the knee or lower leg due to blood leakage from damaged blood vessels.
- Limited Range of Motion: Individuals with a tibial plateau fracture often have trouble moving the knee and may have a reduced range of motion.
- Inability to Bear Weight: Many people with tibial plateau fractures find it challenging or impossible to bear weight on the affected leg due to pain and instability.
- Deformity: In more severe cases or when the fracture involves displacement of the bone, there may be visible deformity or changes in the alignment of the knee.
- Crepitus: Some individuals may experience a grating or crunching sensation (crepitus) when moving the knee, which can be indicative of bone fragments rubbing against each other.
How do you diagnose a tibial plateau fracture?
The combination of a detailed history, comprehensive physical examination, x-rays, and possibly an MRI or CT scan is the key to a successful diagnosis of a tibial plateau fracture. Dr. Bryan Penalosa and his team will complete a thorough exam to evaluate your range of motion, stability, and points of tenderness to palpation. X-rays will be obtained to allow Dr. Bryan Penalosa to assess the integrity of the tibial plateau fracture and the extent of the injury. A CT scan may be ordered by Dr. Bryan Penalosa to further evaluate the severity of the fracture, especially if it is likely that surgery will be required to fix the fracture. An MRI may be ordered to assess for possible associated meniscal, ligamentous, or cartilage injury.
Types of Tibial Plateau Fracture
Tibial plateau fractures can be classified based on various factors, including the specific pattern of the fracture, the amount of displacement, and the involvement of the joint surface.
Location
Lateral Tibial Plateau Split Fracture: This type involves a fracture in the outer (lateral) portion of the tibial plateau. It is often associated with high-energy trauma and may result in instability of the knee joint.
Medial Tibial Plateau Split Fracture: Similar to a lateral tibial plateau fracture, a medial tibial plateau fracture involves a break in the inner (medial) portion of the tibial plateau. It can also lead to instability and may be associated with other injuries.
Bicondylar Fracture: Bicondylar fractures involve both the lateral and medial aspects of the tibial plateau. These fractures are often more complex and may require careful surgical management to restore stability to the knee joint.
Schatzker Classification
The Schatzker classification is a system that categorizes tibial plateau fractures into six types based on the pattern of the fracture lines and the involvement of the joint surface. It helps guide treatment decisions. The types range from less severe (Type I) to more complex (Type VI).
- Schatzker I: Lateral plateau split fracture
- Schatzker II: Lateral plateau split-depressed fracture
- Schatzker III: Lateral plateau pure depression fracture
- Schatzker IV: Medial plateau fracture
- Schatzker V: Bicondylar plateau fracture
- Schatzker VI: Metaphyseal-diaphyseal dissociation
Fracture Pattern
- Split Fracture vs. Depression Fracture: Tibial plateau fractures can also be classified as split fractures, where the bone splits into two separate parts, or depression fractures, where a portion of the bone is depressed into the joint space.
- Impaction Fracture: In an impaction fracture, the force applied to the knee causes compression of the bone, leading to a depression in the tibial plateau. This type may not involve a complete break but can still affect joint function.
Displacement
Non-Displaced vs. Displaced Fractures: Fractures can be categorized as non-displaced (minimal or no shift in bone alignment) or displaced (significant shift or separation of bone fragments). Displacement may impact treatment decisions.
Tibial Avulsion Fracture
A tibial avulsion fracture occurs when a small fragment of bone is pulled away from the tibia due to the force of a muscle or ligament pulling on it. This type of fracture typically involves an avulsion, where the bone fragment is detached at the site where a tendon or ligament attaches. Avulsion fractures can occur in various locations on the tibia, and the specific location depends on the muscle or ligament involved. The most common tibial avulsion fracture involves the ACL. Tibial avulsion fractures can happen during sudden and forceful contractions of the muscles or due to a traumatic event.
Tibial Plateau Fracture Non-Surgical Treatment
Can a tibial plateau fracture be treated without surgery?
The treatment of a tibial plateau fracture without surgery depends on the severity and specific characteristics of the fracture. In some cases, especially with less severe fractures, non-surgical or conservative approaches may be considered. Here are some factors that influence the decision between surgical and non-surgical treatment:
- Non-Displaced Fractures: If the fracture is non-displaced, meaning that the bone fragments are still in proper alignment, conservative measures may be considered.
- Stable Fractures: Stable fractures that do not compromise the stability of the knee joint may be managed without surgery.
For patients who are candidates for non-operative treatment, the focus of care will be on reducing pain, swelling, and inflammation, while also improving overall stability and function of the knee.
Rest and Activity Modification:
During the initial period after the injury, it is essential to rest the knee and avoid activities that worsen the pain.
Oral Anti-Inflammatories, Ice, and Compression:
Oral anti-inflammatory and pain-relieving medications, such as Meloxicam, Naproxen, Advil, or Ibuprofen, may help to manage the pain and reduce inflammation of the knee. Applying ice packs and compression to the knee can also help reduce swelling and inflammation. Remember to use a cloth or towel between the ice pack and your skin to avoid frostbite.
Physical Therapy:
A structured physical therapy program can be beneficial for strengthening the muscles around the knee and improving overall joint stability. A physical therapist can guide you through exercises that focus on the quadriceps, hamstrings, and calf muscles to provide this additional support to the knee. Additionally, proprioceptive training can enhance knee stability. Proprioception is the body’s ability to sense joint position and movement, and improved proprioception can help with knee stability and control during activities. It is important to complete any home exercises that your physical therapist provides to you in order to optimize your recovery.
Immobilizer Brace:
An immobilizer brace or a hinged knee brace locked in extension may be ordered by Dr. Penalosa to be worn for the initial 4-6 weeks following the injury.
Intra-Articular Knee Injections:
The goal of an intra-articular injection is to manage pain and inflammation of the knee. Therefore, injections may be used as a short-term measure to manage these symptoms during an episode of more intense pain. However, it’s crucial to understand that an intra-articular injection will not heal a tibial plateau fracture. Additionally, receiving an intra-articular injection to the knee will delay any surgical intervention for at least 3 months following the administration of the injection.
Tibial Plateau Fracture Surgical Treatment
What are the surgical options for a tibial plateau fracture?
Surgical intervention is often necessary for more severe tibial plateau fractures to restore proper alignment of the bones, reconstruct the joint surface, and stabilize the knee joint. If surgery is needed, it is recommended to proceed as soon as possible following the injury. The specific surgical approach depends on the characteristics of the fracture, including the degree of displacement, the pattern of the fracture, and the involvement of the joint surface.
Tibial Plateau Open Reduction and Internal Fixation (ORIF)
Tibial Avulsion Arthroscopic-Assisted Reduction and Internal Fixation
If you have suffered an ACL tibial avulsion fracture, Dr. Bryan Penalosa will discuss the option of proceeding with an arthroscopic-assisted reduction and internal fixation of the ACL avulsion fracture. During this minimally invasive procedure, Dr. Bryan Penalosa will use sutures that he passes through a small tunnel and secures with a non-metal anchor to reposition the displaced bone fragment back to its anatomical position on the tibia. This will secure the bone fragment in its correct place and restore stability as the bone heals. It will take 6-8 weeks for the bone to heal following an ORIF.
Recovery from Tibial Plateau ORIF Surgery
What is the expected recovery from a tibial plateau ORIF?
Your recovery from a tibial plateau ORIF will begin the first day after your operation. Immediate physical therapy intervention allows for optimal recovery of one’s range of motion and quad re-activation. Subsequent phases of post-operative rehabilitation are strategically outlined to enhance recovery and prevent future injury. Immediately following surgery, you will be non-weight bearing for 6-8 weeks, as the fracture site needs to heal before weight can be applied to the operative leg. Compliance with the non-weightbearing recommendation is critical in overall success from the surgery.
Recovery from a tibial plateau ORIF takes an average of 6-9 months including full rehabilitation to restore range of motion, strengthen the muscles, restore balance, and recover full function. Furthermore, injury prevention after completing the rehabilitation remains of utmost importance to prevent subsequent injuries.