Tibial Plateau Fracture is a serious type of injury that is commonly observed in athletes. It refers to a crack or break in the upper portion of the tibia or the shin bone. This is also known as the proximal tibial fracture. Tibial plateau is the uppermost part of the bone that attaches to the knee joint. It has a honeycomb kind of shape and is relatively softer than the remaining shin bone.
Such fractures may be accompanied by damage to the ligaments, muscles, blood vessels and nerves. These fractures can be categorized as follows:
- Displaced Fractures: The bone pieces are separated from each other or the main joint
- Non-displaced Fractures: The bone may break or crack but remains attached to the main joint in its correct anatomical position
- Transverse: The bone breaks along a straight line
- Comminuted: The bones are shattered into many pieces
Tibial Plateau Fracture can be a serious injury which can be limb threatening. It may cause defects in joint alignment, loss of motion/flexibility and arthritis.
Causes
- A fall from a height
- Vehicular accident
- Sports injuries
- A direct hit or trauma to the outer part of the knee joint
- Slight stress to a weak bone that may be a result of mineral deficiency, cancer, bone infection, or osteoporosis
- Stress caused by increased physical activities
- Age related weakness of the bones make them susceptible to such breaks
- An impact that pushed the edge of the femur into the knee joint and the tibial plateau sinks downwards
Symptoms
- Visibly deformed knee or leg
- Pain which can be severe at the time of weight bearing or activity
- A feeling of pins and needles pricking the limb or foot
- Swelling and tenderness
- The foot below the affected knee may turn cold and pale as the blood supply is hindered
- Numbness in the leg and foot
- Difficulty in bending and moving the joint
Diagnosis
- Details of the patient such as symptoms, medical history, mode of injury and lifestyle
- Examination of the injury through visual observation, palpation and manual manipulation. The doctor will check for open wounds and deformity if any.
- X-ray imaging will be carried out to check bone damage and position. It also helps to diagnose the exact location of the fracture.
- Flow of blood to the limb and the joint may also be checked.
- MRI and CT scans may be required to assess the severity of fracture and additional damage to the soft tissue, if any.
- Arteriogram may be used to check for damaged blood vessels.
Treatment
- Rest the injured leg and avoid bearing weight
- Apply ice packs at regular intervals
- Keep the leg elevated at chest level
- Soft bandage may be used for compression
- Prescription of pain killers, anti inflammatory drugs and antibiotics
- Knee may be immobilized for a short while using a knee brace
- External fixation: A non-surgical procedure in which the displaced bone is fixed back (manually reduced) and held together using screws and pins that are fixed externally for a specified time period.
- Internal fixation: A surgical procedure that involves anatomic reduction of the displaced bone or bone pieces. These are then fixed using metal plates or screws which are left inside the body.
- Fasciotomy: An incision is made to cut open the skin and muscles that cover the joint. The incision is left open for a few days until the blood flow is restored and swelling subsides. This is done only in case of a compartment syndrome.
