Tibial Plateau Fracture

Description

• Synonym: Tibial condylar fracture
• Fracture or depression of the proximal tibial articulating surface
• Valgus or varus force applied in combination with axial loading onto tibial plateau

• Type 1:
  • Split fracture of the lateral tibial plateau without depression of the plateau
• Type 2:
  • Split fracture and depression of lateral tibial plateau
  • Associated with lateral meniscus injury
• Type 3:
  • Central depression of the lateral plateau
  • Injuries may be unstable
• Type 4:
  • Split of the medial tibial plateau
  • Can cause damage to other structures:
    • Popliteal vessels
    • Peroneal nerve
    • MCL
    • Lateral meniscus
    • Lateral collateral ligament
    • Cruciate ligaments
    • Tibial spines
    • Compartment syndrome
• Type 5:
  • Bicondylar tibial plateau fracture
  • Same associated injuries as type 4
• Type 6:
  • Bicondylar, grossly comminuted fracture of the plateau
  • Diaphyseal–metaphyseal dissociation
  • Same associated injuries as types 4 and 5

Etiology

• ∼66% lateral, 25% medial, 11% bicondylar
• Mechanism of injury:
  • Types 1 and 2 from a valgus force with axial loading, generally a low-energy injury
    • Associated with contact sports, twisting motions (e.g., skiing) or classically, pedestrians struck by a vehicle bumper
  • Type 3 are low-energy injuries in osteopenic bone
  • Types 4–6 are high-energy injuries usually from motor vehicle/cycle collisions and falls from height causing medial plateau fractures
    • Associated with neurovascular injuries
• Age associated:
  • Type 1: Younger patients with cancellous bone of the plateau resists depression
  • Types 2 and 3: Depression fractures seen in osteopenic older bones