Tibial head fracture: description
In a tibial plateau fracture, the head of the tibia is broken. Often, the knee joint is also involved. Tibial plateau fractures account for approximately one to two percent of all fractures.
Because the leg axis is aligned in a slightly O-bone shape and the outer bone has a thinner bone structure, fractures on the outer side of the tibia bone are more common. Medical professionals also refer to this fracture as a lateral tibial plateau fracture. Less common is the medial tibial plateau fracture (tibial plateau fracture located toward the center of the body).
There are three different forms of tibial plateau fracture according to the AO classification (AO = Arbeitsgemeinschaft für Osteosynthesefragen):
- A-fractures: fractures in which the joint is not affected (bony ligament avulsion)
- B-fractures: fractures with partial joint involvement such as cleavage fractures, indentation fractures (impression fractures) and impression cleavage fractures
- C fractures: complete joint fractures
The typical symptoms of a tibial plateau fracture are pain and swelling in the knee and lower leg area. A knee joint effusion almost always occurs as well. This is when blood accumulates within the joint capsule. In technical terminology, this is referred to as hemarthrosis. Due to the pain, the affected person can no longer move the knee joint properly.
Often, the cruciate and collateral ligaments are also injured in a tibial plateau fracture. The meniscus may also be affected. If several bone fractures have occurred or if there is a comminuted fracture, there is always a risk of compartment syndrome of the lower leg. In this case, tissue pressure increases due to swelling and blood accumulation, so that nerves, muscles and vessels within a fascia are squeezed. If the tissue is permanently damaged, claw toes can result.
Tibial plateau fracture: causes and risk factors
In younger patients, a cleft fracture often occurs, which may be combined with an indentation fracture (impression fracture). In older patients, osteoporosis (bone loss) often leads to a tibial plateau fracture. Then indentation fractures usually develop.
Ligament injuries in this area are caused by rotational and shear stresses. In about 63 percent of cases, meniscus and cruciate ligament injuries also occur.
Tibial plateau fracture: examinations and diagnosis
The responsible specialist for a tibial plateau fracture is a doctor of orthopedics and trauma surgery. He will first ask you exactly how the accident happened and your medical history (anamnesis). Possible questions are:
- What exactly happened in the accident?
- Are you in pain?
- Can you still move your leg or bend your knee?
- Were there any previous complaints such as pain and restricted movement?
Tibial plateau fracture: Imaging examination
X-rays are taken for further diagnosis of a tibial plateau fracture. This involves x-raying the leg from the side and from the front.
A computed tomography (CT) scan helps plan the surgery that is usually needed. In difficult knee injuries, magnetic resonance imaging (MRI) may be useful. This allows for a more accurate assessment of any meniscus or ligament injuries.
Tibial plateau fracture: treatment
A tibial plateau fracture is initially immobilized in a plaster splint or a Velcro splint to relieve pressure on the leg and allow swelling to subside. As it progresses, such a fracture is rarely treated conservatively. In most cases, surgery is required.
Tibial plateau fracture: Conservative treatment
After the first phase is overcome, the knee joint is usually passively moved through with a motorized splint. The leg can be loaded with a weight of 10 to 15 kilograms with walking sticks and a Velcro splint for about six to eight weeks. After another six to eight weeks, weight-bearing can be slowly increased to half the body weight.
Tibial plateau fracture: surgical treatment
All other cases of tibial plateau fracture are usually treated surgically. The goal of treatment is to restore the joint surface and begin exercises as early as possible. The surgeon screws simple split fractures. He fills the injured joint surface – either with the patient’s own bone material (from the iliac crest) or synthetically produced bone substitute material such as calcium phosphate or hydroxyapatite.
After the operation, the knee joint is moved passively on a regular basis using a motorized splint. The leg should then be relieved for about six to twelve weeks.
Tibial plateau fracture: course of the disease and prognosis
The healing process for a tibial plateau fracture varies. It is monitored by the doctor with regular X-ray checks. With conservative treatment, it takes an average of eight to ten weeks for the fracture to heal. If the tibial plateau fracture is slightly displaced, the long-term prognosis is usually very good. If a tibial plateau fracture is operated on, the prognosis also depends on the patient’s age and existing pre-existing conditions such as joint wear (osteoarthritis) and bone loss (osteoporosis).
Tibial plateau fracture: complications
If the ligaments are involved in the tibial plateau fracture or if it is a comminuted fracture, there is always a risk that the artery of the popliteal artery (A. poplitea) has also been injured. The nerves, on the other hand, are rarely involved.
Other possible complications are wound healing disorders. These often occur if the operation is performed too early, as the tibia is only surrounded by a thin soft tissue sheath. Furthermore, an infection can occur: Then the knee joint must be cleared out and thoroughly rinsed. An infection can also be the cause if the tibial plateau fracture does not heal (pseudoarthrosis).
