Based on their extremely remarkable structure, bones are extremely resilient and even flexible to a certain extent. This is due to the embedded organic and inorganic substances and the beam-like nature of the bones. Nevertheless, these advantages do not always protect against a tibial plateau fracture or a tibia fracture.
What is a tibial plateau fracture?
The medical term tibial plateau fracture is made up of several word parts. The tibia is the shin bone, which is located at the front of the lower leg. A fracture here refers to a broken bone. The tibial head is a specific anatomical area of the tibia that is thickened and represents the transition to the joint. The tibial head is also referred to as the caput tibiae in exact medical terminology. Therefore, when a tibia fracture occurs, there is usually an injury. The tibial plateau fracture is a fairly common trauma that requires intensive treatment and may cause secondary damage as well as complications.
Causes
The causes of a tibial plateau fracture are usually due to the action of mechanical forces, which are primarily sudden and unexpected. These are mainly falls and the impact of the legs from a great height on a non-yielding surface. A tibial plateau fracture can also be caused by internal triggers. These relate to previous damage to the bone structure due to the infiltration of a tumor into the associated weakening of the bone substance, as well as to existing osteoporosis. In this case, the bone loses its stability and a tibial plateau fracture can be the result. If a permanent overload occurs, a tibial plateau fracture is also not excluded. Tibial head fractures occur predominantly as sports or accidental injuries or also occur during unsecured activities in the private household.
Symptoms, complaints, and signs
In a tibial plateau fracture, the tibial plateau is broken. Accordingly, complaints occur mainly in the knee and lower leg area. Externally, swelling is evident there. Patients complain of severe pain, which occurs even when touched. Bruising also occurs regularly. A tibial plateau fracture inevitably leads to restricted mobility. Affected persons can only walk with pain and must be supported. Standing up from a sitting or lying position alone causes problems. Patients are partially dependent on assistance for everyday tasks, such as going to the toilet or getting up in the morning. Only after several weeks of healing can the joint be used again without discomfort. The fracture of the tibial plateau rarely occurs alone. As a result of the accident, the cruciate and collateral ligaments are usually also injured. Even the meniscus, which serves as a shock absorber in the knee joint, may be damaged. Therefore, it is important that the healing process is accompanied by experts. Therapists are involved on a regular basis. If the tibial plateau fracture is not completely healed, permanent sensory disturbances also develop. Patients sometimes report paralysis or sensitivity to the weather. Osteoarthritis may develop. If sufferers adopt a protective posture and place excessive stress on the other tibial plateau, permanent physical deformities may result.
Diagnosis and progression
Because a tibial plateau fracture can occur in different areas of the lower leg, varying symptoms are also experienced. However, common to tibial plateau fracture in all tibial areas is tremendous painful discomfort. Sufferers also notice a tibial plateau fracture by swelling of the tibia. Standing up independently after a tibial plateau fracture is not feasible. In addition, the tibia has lost its complete weight-bearing capacity after a tibial plateau fracture. The lower leg shows an abnormal shape. Bruising and twisting as well as shape abnormalities are indicative of a tibial plateau fracture. Diagnosis and differential diagnosis of a tibial plateau fracture include palpation and motion testing by the physician. Computerized tomography or magnetic resonance imaging and radiography are also indicated. Doppler ultrasonography is also used if a tibial plateau fracture is suspected.
Complications
Various complications can arise because of a fracture of the tibial plateau.For example, the fracture is often associated with impairment of the cruciate ligament, medial collateral ligament or lateral collateral ligament in the knee. It is also not uncommon for the meniscus to be affected, which occurs as a result of splintered bone fragments. Even years after the injury, there is a risk of osteoarthritis of the knee joint. To counteract this unpleasant after-effect, surgical treatment is usually performed. Also among the possible complications of a tibial plateau fracture are injuries to the politeal artery, the artery of the popliteal fossa, which is usually the case with a comminuted fracture. Involvement of the nerves, on the other hand, rarely occurs. However, damage to the fibular nerve is possible with an associated fibular head fracture. A comminuted fracture or an impression fracture (indentation fracture) are also often responsible for knee osteoarthritis. Arthrosis occurs because of inaccurate joint surface reduction. Furthermore, the conceivable effects of tibial plateau fracture include compartment syndrome. As a result of the injury, the muscles swell. Within the lower leg, the muscles accumulate in several compartments or fasciae. If swelling occurs within these closed areas, the muscles no longer have room to expand. This results in the pinching off of the blood supply. Because the tissue is insufficiently supplied with blood, it is in danger of dying. After surgical treatment of the tibial plateau fracture, wound healing problems may occur. This risk is particularly high if surgery is performed too early. Furthermore, infection is possible, which makes healing of the fracture more difficult.
When should you go to the doctor?
If there is severe pain in the limb area after a fall, accident or violence to the body, a doctor should be consulted. If the complaints persist or increase in intensity, the affected person needs a comprehensive examination for a diagnosis. Restrictions on movement, a decrease in physical resilience and discoloration of the skin should be presented to a doctor. If bruising occurs or there are visual changes in the lower leg or knee, these are causes for concern. If the knee joint cannot be bent as usual, if there are changes in the movement sequences or if the affected person needs help to move around, a visit to the doctor should be made. Disturbances in sensitivity, a tingling sensation on the skin or irregularities in blood flow should also be investigated. These are signs of a health disorder for which treatment is needed. If daily responsibilities can no longer be performed independently, if gait unsteadiness is evident, or if behavioral abnormalities are present, consultation with a physician is advised. Paralysis, sensitivity to the weather, a relieving posture of the body or impairments of the musculoskeletal system should be presented to a doctor. Without medical care, there is a risk of consequential or irreparable damage to the skeletal system. If the affected person is unable to engage in normal sports activities due to his or her complaints, he or she should consult a physician.
Treatment and therapy
Treatment of a tibial plateau fracture includes conservative therapy without surgical intervention or surgical straightening of the fracture. The first type of treatment for a tibial plateau fracture involves moving the fracture areas back to their natural position (reduction) and stabilization with a cast, external fixator, or fixed splint. To prevent muscle atrophy due to prolonged immobilization, physiotherapy may be given after a period of time. If the tibial plateau fracture presents a complicated picture, a surgical methodology is used. This involves the insertion of an intramedullary nail and the insertion of special retaining plates. Cross pins or locking systems have also proven to be effective in surgical treatment. These are selected when so-called comminuted and twisted fractures are involved or when the fracture is in the immediate vicinity of the joint. Different components are also selected for split and compression fractures in each case. These stabilizations are compatible with the body and can remain on the bone for an extended period of time. General anesthesia does not have to be given in every case of surgical treatment of a tibial plateau fracture.
Prevention
To prevent tibial plateau fracture and its consequences, it is useful to recognize excessive stress on the lower extremities in time to eliminate the risk of over-fatigue fracture. In all practical activities at high altitude, adequate safety should always be ensured to avoid fractures in case of falls. Since tibial plateau fractures often occur during sports, appropriate warming of the muscles must be undertaken to reduce the risk of fracture.
Aftercare
Follow-up care is required for both conservative and surgical treatment of tibial plateau fracture. It consists primarily of physical therapy measures. These help the patient regain his or her usual range of motion after prolonged immobilization of the tibial plateau. It usually takes two to three months before physiotherapy exercises can be started. In the course of the follow-up treatment, the loads are increased step by step. In this way, overstraining of the tibial head can be avoided. Aftercare of a tibial plateau fracture requires a lot of patience from the patient. Thus, the fracture is roughly healed after about eight to twelve weeks. It takes up to another six weeks before the affected person can move fully again. However, the patient can speed up the healing process. To do this, the patient should put as little weight on the knee as possible. In an emergency, aids can also be used, but this should be done rarely due to the pressure loads. After surgical treatment of the tibial plateau fracture, the patient receives painkilling medication. Pain therapy is considered to be extremely important, as otherwise chronic pain complaints are imminent. In case of surgery, removal of the inserted screws or plates may also be part of the aftercare. Surgical removal depends on the patient’s age and whether the metal pieces cause discomfort.
What you can do yourself
A tibial plateau fracture belongs in immediate medical attention. Self-help measures are not indicated for fractures immediately after the fracture. This is because failure to seek medical treatment or starting therapy too late increases the risk for permanent damage and severe mobility limitations that can last a lifetime. Patients with tibial plateau fractures support medical treatment by following physicians’ instructions regarding physical rest and refraining from certain movements or even sports. In addition, individuals with tibial plateau fracture attend all follow-up appointments with the physician. While the bandage is on the leg, patients especially refrain from physical exertion. After the doctor removes the bandage, patients can use scar care to promote healing of the scar and achieve the most aesthetic result possible. Patients refrain from vigorous physical activity for as long as the attending physician prescribes. After that, the leg must be gradually accustomed to physical exertion again. To this end, patients with tibial plateau fractures usually attend physiotherapy and learn suitable training exercises. Those affected also perform these in their own homes. Shoe inserts may also be prescribed after the fracture to support the skeleton and muscles and prevent poor posture.
