Current Concepts in Management of Tibia Plateau Fracture

Sang Hak Lee; Kang-Il Kim

doi:10.12671/jkfs.2014.27.3.245

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Lee and Kim: Current Concepts in Management of Tibia Plateau Fracture

Review Article

Journal of the Korean Fracture Society 2014; 27(3): 245-260.

Published online: 16 July 2014

DOI: https://doi.org/10.12671/jkfs.2014.27.3.245

Current Concepts in Management of Tibia Plateau Fracture

Sang Hak Lee, M.D., Ph.D., Kang-Il Kim, M.D., Ph.D.

Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.

Address reprint requests to: Kang-Il Kim, M.D., Ph.D. Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul 134-727, Korea. Tel: 82-2-440-7497, Fax: 82-2-440-7498, drkim@khu.ac.kr

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Figures and Tables

Fig. 1

Advantage of the 3-dimensional computed tomography (3D-CT) scan. On a simple radiograph, the fracture appears to have minute displacement and depression, but the fracture involved both condyles with lateral joint depression in 3D-CT view (arrow).

Fig. 2

(A) Associated anterior cruciate ligament injury with Segond's fracture (arrows). (B) Bicondylar fracture combined with a posterior cruciate ligament avulsion fracture.

Fig. 3

(A) Plain radiograph shows a Schatzker type IV fracture. (B) The magnetic resonance image shows associated meniscal injury in the tibial plateau fracture. Lateral meniscus also demonstrated peripheral tear with suggested incarceration within the fracture site (arrow).

Fig. 4

Depressed fracture of the lateral tibial plateau was reduced using an impactor under fluoroscopic guidance.

Fig. 5

Photograph shows the lateral submeniscal approach in the left knee.

Fig. 6

(A, B) Plain radiographs show a complex tibial plateau fracture. (C, D) Computed tomography images indicating that both the lateral and posteromedial column are involved. (E-G) The posteromedial column was reduced with posteromedial approach and buttressed with a locking compression plate.

Fig. 7

(A) Plain radiograph shows a complex tibial plateau fracture (Schatzker type VI). (B) Photograph shows soft tissue swelling with multiple blisters. (C) Bridging external fixation was useful for maintaining alignment and for improvement of the soft tissue swelling.

Fig. 8

(A, B) Plain radiograph and magnetic resonance image show a Schatzker type I fracture. (C) Arthroscopic finding shows step-off of the lateral tibial plateau, (D, E) which was reduced with arthroscopic reduction and internal fixation using a 3.5 mm locking compression plate on the lateral side.

Fig. 9

(A-C) Plain radiograph and computed tomography scan show a Schatzker type II fracture. (D) Arthroscopic finding shows a depressed fracture of the lateral tibial plateau, (E-H) which was reduced with arthroscopic reduction and internal fixation using a 3.5 mm locking compression plate with bone grafting.

Fig. 10

(A, B) Plain radiographs show. (C) The 3-dimensional computed tomography scan shows fracture geometry in the lateral tibial plateau, which divides anterior and posterior fragment.

Fig. 11

Schatzker type IV fracture treated with a locking compression plate using a midline skin incision shows good postoperative alignment of the lower limb.

Fig. 12

(A, B) Plain radiographs show a Schatzker type V fracture (C, D) that was treated with percutaneous plating using a locking compression plate on the lateral side.

Fig. 13

Schatzker type V fracture was initially managed with temporary external fixation (A-E) and treated with a submeniscal approach and dual plating method using a locking compression plate (LCP) on the lateral side and LCP T-plate on the medial side (F-H). The fracture was healed without complication at 14 months after operation (I, J).

Fig. 14

(A-D) Schatzker type VI open fracture with posterior hip dislocation was treated with internal fixation using locking compression plate (LCP) on the lateral side and LCP T-plate on the medial side after temporary maintenance of the limb length and reduction with an external fixator. (E) The fracture was healed without complication at 27 months after operation.

Notes

Financial support: None.

Conflict of interest: None.

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