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Tibial Plateau Fracture

Tibial Plateau Fracture is a topic covered in the 5-Minute Emergency Consult.

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Basics

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

Schatzker Classification of Plateau Fractures
  • 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

  • Mechanism of injury:
    • Types 1 & 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 & 3: Depression fractures seen in osteopenic older bones

Pediatric Considerations
Tibial plateau fractures are rare in children because of the dense cancellous bone of the tibial plateau

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Citation

Rosen, Peter, et al., editors. "Tibial Plateau Fracture." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307185/all/Tibial_Plateau_Fracture.
Tibial Plateau Fracture. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307185/all/Tibial_Plateau_Fracture. Accessed April 24, 2019.
Tibial Plateau Fracture. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307185/all/Tibial_Plateau_Fracture
Tibial Plateau Fracture [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 24]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307185/all/Tibial_Plateau_Fracture.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Tibial Plateau Fracture ID - 307185 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307185/all/Tibial_Plateau_Fracture PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -