Review Question - QID 220386

Figure A demonstrates a lateral split-depression type tibial plateau fracture. A peripheral lateral meniscus tear is the most common soft tissue injury associated with these fractures (Answer 2).

Tibial plateau fractures are periarticular fractures of the knee often associated with soft tissue injury. They occur in a bimodal distribution with younger patients having high-energy mechanisms and older patients having low-energy mechanisms. These injuries require careful examination for neurovascular injury and compartment syndrome. Initial management of these injuries includes external fixation if there is significant soft tissue injury precluding internal fixation, axial instability, or a polytrauma patient who requires further resuscitation before fixation. Open reduction internal fixation is often used as definitive treatment to restore alignment, condylar width, and articular surface. During this procedure, the articular surface is visualized with a submeniscal arthrotomy. Peripheral or tears at the junction between the meniscus and capsule are the most common tear patterns noted.

Gardner et al. conducted a prospective cohort study of 103 patients with operative tibial plateau fractures. All patients received an MRI scan to assess for soft tissue injury. Interestingly, only one patient did not have any soft tissue on MRI. Ninety-one percent of patients had a lateral meniscal injury. Seventy-seven percent of patients had an injury of 1 or more cruciate/collateral ligaments.

Stannard et al. similarly conducted a prospective cohort MRI study of 103 patients with high-energy tibial plateau fractures. The authors found that 71 percent of patients tore at least one ligament, with 53 percent of patients tearing multiple ligaments. There was a significant association between Schatzker IV, V, and VI injuries with the presence of a ligament injury. The authors concluded that clinicians should be aware of the presence of ligament complex injuries in tibial plateau fractures and that these injuries are especially present in higher energy (Schatzker IV, V, and VI) injuries.

Abdel-Hamid et al. conducted a prospective cohort study of 98 patients with operative tibial plateau fractures who underwent arthroscopic-aided open reduction internal fixation. Seventy-one percent of patients had soft tissue injury with 57 percent and 25 percent of patients having meniscal and anterior cruciate ligament injuries, respectively. The authors conclude that the most common soft tissue injuries associated with tibial plateau fractures are peripheral meniscal tears and bony anterior cruciate ligament avulsions.

Figure A demonstrates a lateral split depression (Schatzker II) tibial plateau fracture.

Incorrect Answers:
Answer 1,3-5: The most common soft issue injury associated with a lateral split depression fracture is a peripheral lateral meniscus tear.