Tibial plateau fracture

Background

  • ACL and MCL injuries associated with lateral plateau fracture
  • PCL and LCL associated with medial plateau fracture
  • Compartment syndrome may occur
  • Segond fracture
    • Avulsion fracture of margin of lateral tibial plateau just below joint line
    • Associated with tear of ACL and meniscal ligaments

Clinical Features

  • Occurs via axial load that drives femoral condyle into tibia

Differential Diagnosis

Knee diagnoses

Acute knee injury

Nontraumatic/Subacute

Distal Leg Fractures

Evaluation

Imaging

  • AP, lateral, oblique views (internal for lateral plateau, external for medial plateau). Tunnel view may also be helpful.
    • AP - line drawn at lateral margin of femur should not have >5mm of tibia beyond it
  • CT or MRI should be considered if plain film negative but high clinical suspicion based on mechanism or inability to bear weight

Schatzker Classification

  • Schatzker I Lateral split
  • Schatzker II Split with depression
  • Schatzker III Pure lateral depression
  • Schatzker IV Pure medial depression
  • Schatzker V Bicondylar
  • Schatzker VI Split extends to metadiaphysis

Management

General Fracture Management

Specific Management

  • Knee immobilizer with non-weightbearing and ortho referral in 2-7d
  • Emergent surgical management if open or if neurovascular compromise

Disposition

  • Outpatient follow up

Indications for Expedited Referral (within 48hr)

  • Significant displacement or depression
  • Suspected or documented ligamentous injury

Indications for (outpatient) surgery

  • Articular stepoff > 3mm
  • Condylar widening > 5mm
  • Varus/valgus instability
  • All medial plateau fractures
  • All bicondylar fractures

See Also

References

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