Complications
Complications are not uncommon, particularly in the case of luxation fractures. The splintered bone fragments can damage surrounding ligaments of the knee joint (inner, outer or cruciate ligaments) as well as the menisci. Due to the damaged parts of the joint, arthrosis of the knee joint may occur over the years after the injury.
To prevent this, a tibial head fracture usually has to be treated surgically. Another special complication is the so-called compartment syndrome. Here, the injury results in swelling of the muscles.
The muscles of the lower leg are located in individual compartments or fasciae. If swelling occurs within these closed compartments, the muscles do not have enough room to expand. As a result, the blood supply is quickly cut off.
The tissue is less supplied with blood and is at high risk of dying. In the clinic, the pressure in the muscle boxes is therefore measured in order to detect compartment syndrome at an early stage. In such a case, the muscle fasciae are surgically split. The lower leg is left open for a period of time at the operation scar so that the lower leg muscles can expand and blood circulation to the tissue is ensured.
Diagnosis
To diagnose a tibial plateau fracture, x-rays of the affected leg must be taken in several planes. On these, a fracture gap can usually already be clearly identified. Alternatively, such a bone fracture can be visualized by means of computed tomography (CT).
An MRI examination is only suitable to show accompanying ligament or meniscus injuries. In some cases, an additional knee joint endoscopy (arthroscopy) is performed before surgery, so that the physician can see exactly how much and where the knee joint is internally damaged. This has consequences for the therapeutic procedure.In addition to diagnosing the tibial plateau fracture itself, the doctor must also rule out complications such as compartment syndrome.
He will check whether the sensitivity of the entire leg is preserved. He will also palpate the foot pulses. If these are not palpable, this could indicate a compartment syndrome.
A pressure measurement within the muscle boxes is also pioneering. In principle, there is the possibility of conservative or surgical treatment of the tibial plateau fracture. The conservative therapy is actually only possible if the bone fragments of the fracture all remain in position and are not shifted against each other.
It is also used, for example, in very old patients with many concomitant diseases who would not be able to cope with anesthesia. In conservative therapy, the leg is put in a plaster cast for about one month so that the bone fragments do not shift and grow back in position. If there is a luxation fracture, the bone fragments must first be brought back into their correct position before plastering.
This is achieved with the so-called extension therapy, in which traction is applied to the affected leg, thereby stretching it. This allows the bone pieces to be brought back into their correct position. Following the plaster treatment, physiotherapeutic exercises are very important to restore and improve mobility in the injured knee joint.
The knee is usually fully resilient again after about eight to twelve weeks. However, the overall result of conservative therapy is usually not as good as that of surgical treatment of the injury. In the vast majority of cases, a tibial head fracture is treated surgically.
This can minimize the risk of consequential damage (for example, osteoarthritis in the affected knee). The bone fragments are fixed in their correct anatomical position during surgery using plates or screws. Special care must be taken to reconstruct the tibial plateau in an anatomically correct manner, since it forms an articular surface of the knee joint.
Otherwise, if the fit is not accurate, incorrect loading and further consequential damage to the knee joint may develop. The operation is also followed by intensive physiotherapeutic treatment for about three months, which serves to mobilize and stabilize the knee joint. The muscles must be strengthened so that they can optimally stabilize the operated knee joint.
- Conservative therapy
- Surgical therapy
