Tibial Plateau Fracture

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Physical Therapy Videos - Knee

Basic Anatomy

The tibial plateau is the flat top portion of your tibia bone, which runs from your knee to your ankle. The bottom end of your thigh bone (femur) and the top end of your tibia form your knee joint. The tibial plateau is a relatively flat surface of bone covered in cartilage. This is a very smooth, low-friction surface, designed to allow your knee joint to bend and straighten. There are two menisci, or shock absorbers made of cartilage, that sit between your tibia and the femur. These are commonly injured in sports activities.

There is a large blood vessel that runs behind your knee. The main nerves that supply your leg and foot are also found in the back of your knee, and two of them wrap around the outside of your knee.

Skeleton model showing the knee joint.
Figure 1: Skeleton model showing the knee joint.

 

X-rays of the knee.
Figure 2: X-rays of the knee.

Mechanism and Epidemiology

A tibial plateau fracture is an injury in which you break your bone and injure the cartilage that covers the top end of your tibia (bottom part of your knee). The break can range from a single crack in your bone to shattering into many pieces. This fracture typically happens after a fall or a motor vehicle accident. High energy injuries like these cause your thigh bone (femur) to drive into your tibia like a hammer hitting an anvil.

An example of a patient with a tibial plateau fracture.
Figure 3: An example of a patient with a tibial plateau fracture. The red arrows point to the broken areas of the bone.

 

Photograph showing the swelling and bruising that is seen after a tibial plateau fracture.
Figure 4: Photograph showing the swelling and bruising that is seen after a tibial plateau fracture. The knee in on the right is very swollen after suffering a break in the bone after a fall.

Initial Treatment

After you break your tibial plateau it will be very painful, and you will most likely not be able to walk on it. You will likely need to go to an emergency room because of the pain. In the emergency room you will get x-rays as well as a CT scan. Depending on how bad the break is, you may be able to go home or you may be admitted to the hospital. Often, you will be put into a brace or a splint. Either way you will not be able to walk or put weight on the leg.

Sometimes the break is so bad you need to be taken to the operating room to have an external fixator put on. An external fixator is a device made up of pins that are put in your femur (thigh bone) and tibia (leg bone) and bars that connect the pins together. This is a temporary way of holding the leg and bones in a better position (lines them up) and allows the swelling to go down until it is safe to fix your bone with plates and screws.

You may also be admitted to the hospital to make sure you don’t have too much swelling after your break. Too much swelling of the leg can cause serious problems putting your leg, nerves, and muscles at risk of permanent injury.

General Treatment

Depending on where the break is and how well it is lined up, tibial plateau fractures may be treated with or without surgery. Your surgeon will discuss this with you and give you options for treatment. If your fracture can be treated without surgery, you may be kept in a brace or a splint for a period of time. Generally, you will not be allowed to put weight on your leg for 6 to 12 weeks. Once you do start putting weight on the leg, it will just be a little bit to begin with and then you can slowly increase the amount over time.

If your bone is broken in many places or it is not lined up correctly, you may require surgery. Your surgeon will evaluate your skin and swelling to decide when he or she thinks you are ready for surgery. It may take several days to several weeks. Once surgery is safe to do, your surgeon will make cuts in your leg to line your bones back up. Depending on how your bones are broken, these cuts may be on the front of your knee, the side of your knee, or both. There is rarely a need to make an incision on the back of the knee. Plates, screws, and pins may be used to hold the bones in place. Sometimes, additional bone from either yourself or a cadaver is used to help repair the break. Bone substitute may also be used. This decision will be made by your surgeon.

X-rays of a knee after tibial plateau fracture surgery, with plate and screws.
Figure 5: X-rays of a knee after tibial plateau fracture surgery, with plate and screws. The left image is a front view and the right is a side view. A white cloudy material (calcium phosphate) was injected into the bone to support the fracture as well.

 

X-rays of a patient that broke both tibial plateaus very badly.
Figure 6: X-rays of a patient that broke both tibial plateaus very badly. These required several weeks in external fixators before definitive surgery.

Post-operative Care

You will not be able to bear weight on your leg for weeks after breaking your bone. That means no walking on or pushing off of your broken leg. This is to keep the bones from moving as you heal. Depending on your injury, this will last 6 to 12 weeks. You may need to use crutches, a walker and/or a wheelchair. A knee immobilizer or hinged knee brace may be used to provide support for your leg. You will be instructed to work on gentle motion of your knee, ankle, and hip. This is to prevent stiffness and also to help your cartilage to heal. Your surgeon will let you know how much you should bend your knee. You may be prescribed physical therapy to help with motion and strength. It is important to follow up with your surgeon to make sure your bones are healing well and that your motion is good.

Long Term

Tibial plateau fractures injure the joint surface cartilage. The injured knee joint can develop arthritis. The symptoms include pain with use, stiffness, swelling, and inability to tolerate exercise, stairs, or running. Some patients have bad enough arthritis that they have a knee replacement to help improve their pain and function.

Stiffness and some weakness is very common. Physical therapy may be able to help with this. You may have a permanent limp and need to use a cane or assistive device. Rarely, more serious complications may require more surgery, hospital stays, or medications. These complications include swelling, infection, blood clots, and painful hardware.

X-rays of post-traumatic arthritis after a tibial plateau fracture.
Figure 7: X-rays of post-traumatic arthritis after a tibial plateau fracture.

 

Physical Therapy Videos - Knee

More Information

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Erik Lund, MD
Edited by the OTA Patient Education Committee
All x-rays and pictures taken from the personal collection of Dr. Lund and Christopher Domes, MD

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