TIBIAL PLATEAU FRACTURES

Tibial plateau fractures result from a vertical or lateral force driving the femoral condyles into the tibial articular surface of the knee.

The most unstable fractures involve both plateaux and cross the tibial shaft (Figure 18.53).

Figure 18.53

Evaluation

The knee is swollen, painful and shows deformity at the location of the injury. X-rays determine the location of the fracture and indicate the treatment.

Perform a careful examination of the neurological and vascular functions at the foot and ankle. Injury to the popliteal artery requires immediate repair if the leg is to be saved.

Treatment

Non-displaced fractures

Treat non-displaced fractures, and fractures with less than 5 mm of articular surface depression, in a splint initially. In 1–2 weeks, begin a range of motion out of the splint. Keep the patient non-weight bearing for 6 weeks and partial weight bearing with crutches or a stick for an additional 6 weeks.

Displaced fractures

Treat displaced or unstable fractures by closed reduction followed by a cast, calcaneal traction or surgical reduction and internal fixation.