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Tibial Plateau Fractures

  - Discussion:
- 60% of plataue frxs involve lateral plateau.
- this probably is result of valgus alignment of lower extremity and fact that most injuring forces are
directed laterally to medially;
- frxs of medial plateau make up 15% & bicondylar lesions 25% of plateau frx;
- bicondylar frxs combine any of unicondylar lesions w/ frx of metaphysis;
- expected frx patterns:
- lateral split fragment - found in 75%;
- posteromedial fragment - seen in 43%;
- tibial tubercle fragment - seen in 16%;
- zone of comminution that including the tibial spine - frequently extends to the lateral
condyle - seen in 28%
- references:
- Tibial Plateau Fracture Characteristics: Computed Tomography Mapping of Lateral, Medial, and Bicondylar Fractures
- partial or complete ligamentous ruptures occur in about 15% to 45% & meniscal lesions in about 5-37% of all tibial plateau frx;
- AO Classification:
- Type I Fracture / Minimally Displaced Fractures
- Type II Fracture: / Split Compression Fractures
- Type III Fracture: / Local Compression Fracture
- Type IV Fractures: / Medial Tibial Plateua Fractures
- Type V Fractures: / Bicondylar Fractures
- Type VI Fractures:
- ref: Classifications in Brief: Schatzker Classification of Tibial Plateau Fractures
- Misc Tibial Plateau
          - Fracture Dislocations
- Frx of the Fibula and Tibial Plateua fractures
- Ligamentous Injuries in Tibial Plateau Fractures
- Rim Fractures
- Split Fractures
- Total Depression Fracture
- reference:
- Classification of fractures of the tibial condyles.

- Exam:
- skin abrasion and contussions from direct blows;
compartment syndrome: occurs in 11%
- ref: Radiographic Predictors of Compartment Syndrome in Tibial Plateau Fractures
- ligamentous instability
- peroneal nerve function;

- Radiographic Studies
- How much articular displacement can be detected using fluoroscopy for tibial plateau fractures?

- Non Operative Treatment
- references:
Closed reduction of tibial plateau fractures. A comparison of functional and roentgenographic end results.
The cast brace and tibial plateau fractures.
Cast brace treatment of proximal tibia fractures. A ten-year follow-up study.
Fractures of the tibial plateau. Treatment by closed reduction and spica cast.
Tibial plateau fractures. A comparison of conservative and surgical treatment.

- Operative Management:
    - Work Up and PreOp Planning:
           - references:
- Acute compartment syndrome in tibial plateau fractures--beware!
- Influence of prior fasciotomy on infection after open reduction and internal fixation of tibial plateau fractures.
                   - Does Early versus Delayed Spanning External Fixation Impact Complication Rates for High-energy Tibial Plateau and Plafond Fractures?

Surgical Approaches:
- Lateral Plateau
- Medial Plateau

    - Percutaneous Fixation:
           - references:
- Percutaneous Screw Fixation of Tibial Plateau Fractures.
- Closed reduction and percutaneous screw fixation for tibial plateau fractures
- Indirect reduction and percutaneous screw fixation of displaced tibial plateau fractures.
- How much articular displacement can be detected using fluoroscopy for tibial plateau fractures?
Elective removal of implants after open reduction and internal fixation of Tibial Plateau fractures improves clinical outcomes.
- IM Nailing:

- A comparative study for complex tibial plateau fractures: nailing and compression bolts versus modern and traditional plating.
- The management of complex fractures of the proximal tibia with minimal intra-articular impaction in fragility patients using intramedullary nailing and compression bolts.

    - Adjunctive Procedures:
           - Bone Grafting:
                  - references:
- Interporous hydroxyapatite as a bone graft substitute in tibial plateau fractures.
- Factors influencing the results of open reduction and internal fixation of tibial plateau fractures.
- Comparison of autogenous bone graft and endothermic Ca phos cement for defect augmentation in tibial plateau frx.
- Outcomes of Schatzker II tibial plateau fracture open reduction internal fixation using structural bone allograft.
- Impaction bone grafting has potential as an adjunct to the surgical stabilisation of osteoporotic tibial plateau fractures:

    - Role of Arthroscopy: (see arthroscopy of the knee)
- advantages:
- reduced postoperative pain and swelling;
- early recovery of knee motion, and less postoperative knee stiffness;
- reduced risk of infection
- minimal fragment devascularization
- direct visualization of the articular surface: meniscal lesions (20% of the patients) and osteochondral detachments(25%
of the patients)
- disadvantages:
-  lack of rigid fixation and the need for delayed weight-bearing.
- references:
- Arthroscopy of meniscal injuries with tibial plateau fractures.
- The Role of Arthroscopy in the Management of Tibial Plateau Fractures.
- Arthroscopic Restoration of Depressed Tibial Plateau Fractures Using Bone and Hydroxyapatite Grafts.
- Arthroscopic Management of Tibial Plateau Fractures.
- Arthroscopically assisted treatment of lateral tibial plateau fractures in skiers: use of a cannulated reduction system.
- Arthroscopic Management of Tibial Plateau Fractures.
- Arthroscopic Management of Tibial Plateau Fractures.
- The Role of Arthroscopy in the Assessment and Treatment of Tibial Plateau Fractures.
- Combined arthroscopic treatment of tibial plateau and intercondylar eminence avulsion fractures.
- [Comparison study on effectiveness between arthroscopy assisted percutaneous internal fixation and open reduction and internal fixation for Schatzker types II and III tibial plateau fractures].
- Operatively Treated Meniscal Tears Associated with Tibial Plateau Fractures: A Report on 661 Patients.

- Post Operative Care and Complications
- references:
- Effect of tibial plateau fracture on lubrication function and composition of synovial fluid

Tibial plateau fractures. Management and expected results.

Fractures of the tibial plateau: a review of ninety-five patients and comparison of treatment methods.

Indications for surgical treatment of tibial condyle fractures.

Immediate internal fixation of open, complex tibial plateau fractures: treatment by a standard protocol.

Tibial Plateau Fractures.

Limited Internal Fixation of Tibial Plateau Fractures. Rangitsch MR , et al. J Orthop Trauma. 1993;7:168.