Journal List > J Korean Fract Soc > v.27(3) > 1037993

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

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).
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Fig. 2
(A) Associated anterior cruciate ligament injury with Segond's fracture (arrows). (B) Bicondylar fracture combined with a posterior cruciate ligament avulsion fracture.
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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).
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Fig. 4
Depressed fracture of the lateral tibial plateau was reduced using an impactor under fluoroscopic guidance.
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Fig. 5
Photograph shows the lateral submeniscal approach in the left knee.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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).
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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.
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Notes

Financial support: None.

Conflict of interest: None.

References

1. Lin S, Mauffrey C, Hammerberg EM, Stahel PF, Hak DJ. Surgical site infection after open reduction and internal fixation of tibial plateau fractures. Eur J Orthop Surg Traumatol. 2014; 24:797–803.
crossref
2. Moore TM, Patzakis MJ, Harvey JP. Tibial plateau fractures: definition, demographics, treatment rationale, and long-term results of closed traction management or operative reduction. J Orthop Trauma. 1987; 1:97–119.
3. Scott WN. Insall & scott surgery of the knee. 4th ed. Philadelphia: Churchill Livingstone;2006. p. 1133–1146.
4. Young MJ, Barrack RL. Complications of internal fixation of tibial plateau fractures. Orthop Rev. 1994; 23:149–154.
5. Brunner A, Horisberger M, Ulmar B, Hoffmann A, Babst R. Classification systems for tibial plateau fractures; does computed tomography scanning improve their reliability? Injury. 2010; 41:173–178.
crossref
6. Doornberg JN, Rademakers MV, van den Bekerom MP, et al. Two-dimensional and three-dimensional computed tomography for the classification and characterisation of tibial plateau fractures. Injury. 2011; 42:1416–1425.
crossref
7. Macarini L, Murrone M, Marini S, Calbi R, Solarino M, Moretti B. Tibial plateau fractures: evaluation with multidetector-CT. Radiol Med. 2004; 108:503–514.
8. Markhardt BK, Gross JM, Monu JU. Schatzker classification of tibial plateau fractures: use of CT and MR imaging improves assessment. Radiographics. 2009; 29:585–597.
crossref
9. Barei DP, Nork SE, Mills WJ, Coles CP, Henley MB, Benirschke SK. Functional outcomes of severe bicondylar tibial plateau fractures treated with dual incisions and medial and lateral plates. J Bone Joint Surg Am. 2006; 88:1713–1721.
crossref
10. Lobenhoffer P. Posterolateral transfibular approach to tibial plateau fractures. J Orthop Trauma. 2011; 25:e31. author reply e31.
crossref
11. Cannada LK, Anglen JO, Archdeacon MT, Herscovici D Jr, Ostrum RF. Avoiding complications in the care of fractures of the tibia. Instr Course Lect. 2009; 58:27–36.
12. Chang YH, Tu YK, Yeh WL, Hsu RW. Tibial plateau fracture with compartment syndrome: a complication of higher incidence in Taiwan. Chang Gung Med J. 2000; 23:149–155.
13. Gardner MJ, Yacoubian S, Geller D, et al. The incidence of soft tissue injury in operative tibial plateau fractures: a magnetic resonance imaging analysis of 103 patients. J Orthop Trauma. 2005; 19:79–84.
crossref
14. Mui LW, Engelsohn E, Umans H. Comparison of CT and MRI in patients with tibial plateau fracture: can CT findings predict ligament tear or meniscal injury? Skeletal Radiol. 2007; 36:145–151.
crossref
15. Shepherd L, Abdollahi K, Lee J, Vangsness CT Jr. The prevalence of soft tissue injuries in nonoperative tibial plateau fractures as determined by magnetic resonance imaging. J Orthop Trauma. 2002; 16:628–631.
crossref
16. Marsh JL, Slongo TF, Agel J, et al. Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma. 2007; 21:S1–S133.
17. Tejwani NC, Hak DJ, Finkemeier CG, Wolinsky PR. High-energy proximal tibial fractures: treatment options and decision making. Instr Course Lect. 2006; 55:367–379.
18. Biggi F, Di Fabio S, D'Antimo C, Trevisani S. Tibial plateau fractures: internal fixation with locking plates and the MIPO technique. Injury. 2010; 41:1178–1182.
crossref
19. Koval KJ, Sanders R, Borrelli J, Helfet D, DiPasquale T, Mast JW. Indirect reduction and percutaneous screw fixation of displaced tibial plateau fractures. J Orthop Trauma. 1992; 6:340–346.
crossref
20. Lowe JA, Tejwani N, Yoo BJ, Wolinsky PR. Surgical techniques for complex proximal tibial fractures. Instr Course Lect. 2012; 61:39–51.
21. Abdel-Hamid MZ, Chang CH, Chan YS, et al. Arthroscopic evaluation of soft tissue injuries in tibial plateau fractures: retrospective analysis of 98 cases. Arthroscopy. 2006; 22:669–675.
crossref
22. Burdin G. Arthroscopic management of tibial plateau fractures: surgical technique. Orthop Traumatol Surg Res. 2013; 99:S208–S218.
crossref
23. Chiu CH, Cheng CY, Tsai MC, et al. Arthroscopy-assisted reduction of posteromedial tibial plateau fractures with buttress plate and cannulated screw construct. Arthroscopy. 2013; 29:1346–1354.
crossref
24. Fowble CD, Zimmer JW, Schepsis AA. The role of arthroscopy in the assessment and treatment of tibial plateau fractures. Arthroscopy. 1993; 9:584–590.
crossref
25. Kim DH, Lee GC, Choi KY, Cho SW, Ha SH. Arthroscopic assisted intra-articular reduction and internal fixation of tibia plateau fracture. J Korean Fract Soc. 2013; 26:191–198.
crossref
26. Chang SM, Wang X, Zhou JQ, Huang YG, Zhu XZ. Posterior coronal plating of bicondylar tibial plateau fractures through posteromedial and anterolateral approaches in a healthy floating supine position. Orthopedics. 2012; 35:583–588.
crossref
27. Cherney S, Gardner MJ. Bicondylar tibial plateau fractures: assessing and treating the medial fragment. J Knee Surg. 2014; 27:39–45.
crossref
28. Luo CF, Sun H, Zhang B, Zeng BF. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma. 2010; 24:683–692.
crossref
29. He X, Ye P, Hu Y, et al. A posterior inverted L-shaped approach for the treatment of posterior bicondylar tibial plateau fractures. Arch Orthop Trauma Surg. 2013; 133:23–28.
crossref
30. Oh JK, Oh CW, Hahn SB, Roh KJ, Lee KH. Treatment of complex tibial plateau fractures: a modified patient positioning for the combined anterior and posterior approaches. J Korean Fract Soc. 2006; 19:396–400.
crossref
31. Partenheimer A, Gösling T, Müller M, et al. Management of bicondylar fractures of the tibial plateau with unilateral fixed-angle plate fixation. Unfallchirurg. 2007; 110:675–683.
32. Solomon LB, Stevenson AW, Baird RP, Pohl AP. Posterolateral transfibular approach to tibial plateau fractures: technique, results, and rationale. J Orthop Trauma. 2010; 24:505–514.
crossref
33. Tao J, Hang DH, Wang QG, et al. The posterolateral shearing tibial plateau fracture: treatment and results via a modified posterolateral approach. Knee. 2008; 15:473–479.
crossref
34. Zhang W, Luo CF, Putnis S, Sun H, Zeng ZM, Zeng BF. Biomechanical analysis of four different fixations for the posterolateral shearing tibial plateau fracture. Knee. 2012; 19:94–98.
crossref
35. Chen WT, Zhang YQ, Chang SM. Posterolateral approach for plating of tibial plateau fractures and the risk of injury to the anterior tibial vessels. J Orthop Trauma. 2013; 27:e228–e229.
crossref
36. Huang YG, Chang SM. The posterolateral approach for plating tibial plateau fractures: problems in secondary hardware removal. Arch Orthop Trauma Surg. 2012; 132:733–734.
crossref
37. Apley AG. Fractures of the tibial plateau. Orthop Clin North Am. 1979; 10:61–74.
crossref
38. DeCoster TA, Nepola JV, el-Khoury GY. Cast brace treatment of proximal tibia fractures. A ten-year follow-up study. Clin Orthop Relat Res. 1988; (231):196–204.
39. Drennan DB, Locher FG, Maylahn DJ. Fractures of the tibial plateau. Treatment by closed reduction and spica cast. J Bone Joint Surg Am. 1979; 61:989–995.
crossref
40. Bozkurt M, Turanli S, Doral MN, et al. The impact of proximal fibula fractures in the prognosis of tibial plateau fractures: a novel classification. Knee Surg Sports Traumatol Arthrosc. 2005; 13:323–328.
crossref
41. Choi JY, Shin YW, Lee BJ. Analysis of risk factors for the posterolateral articular depression and status of posterolateral fragment in lateral condylar and bicondylar tibial plateau fractures with joint depression. J Korean Fract Soc. 2013; 26:241–247.
crossref
42. Cho KY, Oh HS, Yoo JH, Kim DH, Cho YJ, Kim KI. Treatment of schatzker type V and VI tibial plateau fractures using a midline longitudinal incision and dual plating. Knee Surg Relat Res. 2013; 25:77–83.
crossref
43. Cift H, Cetik O, Kalaycioglu B, Dirikoglu MH, Ozkan K, Eksioglu F. Biomechanical comparison of plate-screw and screw fixation in medial tibial plateau fractures (Schatzker 4). A model study. Orthop Traumatol Surg Res. 2010; 96:263–267.
crossref
44. Gosling T, Schandelmaier P, Muller M, Hankemeier S, Wagner M, Krettek C. Single lateral locked screw plating of bicondylar tibial plateau fractures. Clin Orthop Relat Res. 2005; 439:207–214.
crossref
45. Hasan S, Ayalon OB, Yoon RS, et al. A biomechanical comparison between locked 3.5-mm plates and 4.5-mm plates for the treatment of simple bicondylar tibial plateau fractures: is bigger necessarily better? J Orthop Traumatol. 2014; 15:123–129.
crossref
46. Jiang R, Luo CF, Wang MC, Yang TY, Zeng BF. A comparative study of Less Invasive Stabilization System (LISS) fixation and two-incision double plating for the treatment of bicondylar tibial plateau fractures. Knee. 2008; 15:139–143.
crossref
47. Kraus TM, Martetschläger F, Müller D, et al. Return to sports activity after tibial plateau fractures: 89 cases with minimum 24-month follow-up. Am J Sports Med. 2012; 40:2845–2852.
crossref
48. Weaver MJ, Harris MB, Strom AC, et al. Fracture pattern and fixation type related to loss of reduction in bicondylar tibial plateau fractures. Injury. 2012; 43:864–869.
crossref
49. Chae IJ, Park SW, Lee SH, Noh W, Kim HJ, Hahn SB. Treatment of Shatzker type VI tibia plateau fracture using lateral and posteromedial dual incision approach and dual plating. J Korean Fract Soc. 2009; 22:252–258.
crossref
50. Musahl V, Tarkin I, Kobbe P, Tzioupis C, Siska PA, Pape HC. New trends and techniques in open reduction and internal fixation of fractures of the tibial plateau. J Bone Joint Surg Br. 2009; 91:426–433.
crossref
51. Zhang Y, Fan DG, Ma BA, Sun SG. Treatment of complicated tibial plateau fractures with dual plating via a 2-incision technique. Orthopedics. 2012; 35:e359–e364.
crossref
52. Liu YP, Yu GR. Posterolateral approaches for the treatment of tibial plateau fractures and total knee arthroplasty. J Orthop Trauma. 2011; 25:e83–e84. author reply e84-85.
53. Muhm M, Schneider P, Ruffing T, Winkler H. Posterocentral approach to the posterior tibial plateau: Reconstruction of tibial plateau fractures and avulsions of the posterior cruciate ligament. Unfallchirurg. 2013; [Epub].
54. Anglen JO, Aleto T. Temporary transarticular external fixation of the knee and ankle. J Orthop Trauma. 1998; 12:431–434.
crossref
55. Egol KA, Tejwani NC, Capla EL, Wolinsky PL, Koval KJ. Staged management of high-energy proximal tibia fractures (OTA types 41): the results of a prospective, standardized protocol. J Orthop Trauma. 2005; 19:448–455. discussion 456.
56. Haidukewych GJ. Temporary external fixation for the management of complex intra- and periarticular fractures of the lower extremity. J Orthop Trauma. 2002; 16:678–685.
crossref
57. Oh JK. Treatment of complex tibial plateau fractures. J Korean Fract Soc. 2005; 18:349–358.
crossref
58. Westmoreland GL, McLaurin TM, Hutton WC. Screw pullout strength: a biomechanical comparison of large-fragment and small-fragment fixation in the tibial plateau. J Orthop Trauma. 2002; 16:178–181.
crossref
59. Karunakar MA, Egol KA, Peindl R, Harrow ME, Bosse MJ, Kellam JF. Split depression tibial plateau fractures: a biomechanical study. J Orthop Trauma. 2002; 16:172–177.
crossref
60. Koval KJ, Polatsch D, Kummer FJ, Cheng D, Zuckerman JD. Split fractures of the lateral tibial plateau: evaluation of three fixation methods. J Orthop Trauma. 1996; 10:304–308.
crossref
61. Schatzker J. Compression in the surgical treatment of fractures of the tibia. Clin Orthop Relat Res. 1974; (105):220–239.
crossref
62. Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968--1975. Clin Orthop Relat Res. 1979; (138):94–104.
63. Ruiz-Ibán MÁ, Diaz-Heredia J, Elías-Martín E, Moros-Marco S, Cebreiro Martinez Del Val I. Repair of meniscal tears associated with tibial plateau fractures: a review of 15 cases. Am J Sports Med. 2012; 40:2289–2295.
crossref
64. Mauffrey C, Seligson D, Lichte P, Pape HC, Al-Rayyan M. Bone graft substitutes for articular support and metaphyseal comminution: what are the options? Injury. 2011; 42:Suppl 2. S35–S39.
crossref
65. Chan KK, Resnick D, Goodwin D, Seeger LL. Posteromedial tibial plateau injury including avulsion fracture of the semimembranous tendon insertion site: ancillary sign of anterior cruciate ligament tear at MR imaging. Radiology. 1999; 211:754–758.
crossref
66. Weil YA, Gardner MJ, Boraiah S, Helfet DL, Lorich DG. Posteromedial supine approach for reduction and fixation of medial and bicondylar tibial plateau fractures. J Orthop Trauma. 2008; 22:357–362.
crossref
67. Bucholz RW, Court-Brown CM, Heckman JD, Tornetta P. Rockwood and Green's fractures in adults. 7th ed. Philadelphia: Lippincott;2010. p. 1780–1831.
68. Tejwani NC, Achan P. Staged management of high-energy proximal tibia fractures. Bull Hosp Jt Dis. 2004; 62:62–66.
69. Mahadeva D, Costa ML, Gaffey A. Open reduction and internal fixation versus hybrid fixation for bicondylar/severe tibial plateau fractures: a systematic review of the literature. Arch Orthop Trauma Surg. 2008; 128:1169–1175.
crossref
70. Maroto MD, Scolaro JA, Henley MB, Dunbar RP. Management and incidence of tibial tubercle fractures in bicondylar fractures of the tibial plateau. Bone Joint J. 2013; 95:1697–1702.
crossref
71. Yoon YC, Oh JK, Oh CW, Sahu D, Hwang JH, Cho JW. Inside out rafting K-wire technique for tibial plateau fractures. Arch Orthop Trauma Surg. 2012; 132:233–237.
crossref
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