Summary Tibial Plateau fractures are periarticular injuries of the proximal tibia frequently associated with soft tissue injury. Diagnosis is made with knee radiographs but frequently require CT scan for surgical planning. Treatment is often ORIF in the acute setting versus delayed fixation after soft tissue swelling subsides. Epidemiology Incidence 1-2% of all fractures 10.3 per 100,000 people annually Demographics mean age 52 bimodal distribution login to view 2 more bullets Location lateral plateau 70-80% bicondylar 10-30% medial plateau 10-20% Etiology Mechanism Vector of applied load, amount of energy, and quality of bone determine type of fracture login to view 13 more bullets Associated conditions meniscal tears login to view 7 more bullets ACL injuries login to view 1 more bullet compartment syndrome associated soft tissue injuries have little bearing on final outcomes neurovascular injury login to view 4 more bullets Anatomy Osteology lateral tibial plateau login to view 3 more bullets medial tibial plateau login to view 2 more bullets alignment of proximal tibia login to view 4 more bullets Ligaments ACL login to view 3 more bullets PCL login to view 2 more bullets MCL login to view 7 more bullets LCL login to view 2 more bullets Meniscus lateral meniscus login to view 3 more bullets medial meniscus login to view 1 more bullet Muscles 4 compartments in lower leg login to view 4 more bullets Tendons patellar tendon login to view 1 more bullet iliotibial band login to view 1 more bullet hamstring tendons login to view 1 more bullet Neurovascular structures popliteal artery runs just posterior to knee capsule and bifurcates login to view 2 more bullets tibial nerve login to view 3 more bullets common peroneal nerve login to view 8 more bullets Biomechanics medial tibial condyle login to view 1 more bullet lateral tibial condyle login to view 1 more bullet Kinematics flexion-extension 0-140 degrees login to view 1 more bullet posterior femoral rollback login to view 6 more bullets Classification Schatzker classification Schatzker Classification Type I Lateral split fracture young patient with strong subchondral bone Type II Lateral Split-depressed fracture most common Type III Lateral Pure depression fracture uncommon, elderly osteoporotic Type IV Medial plateau fracture associated fx-dislocation high rate of NV and ligamentous injuries Type V Bicondylar fracture tibial spines remain continuous with shaft Type VI Metaphyseal-diaphyseal disassociation significant soft-tissue injury Hohl and Moore Classification Useful for login to view 3 more bullets Hohl and Moore Classification of proximal tibia fracture-dislocations Type I Coronal split fracture Type II Entire condylar fracture Type III Rim avulsion fracture of lateral plateau Type IV Rim compression fracture Type V Four-part fracture 3-column concept tibial plateau divided into 3 columns login to view 3 more bullets utility login to view 2 more bullets Presentation History mechanism of injury login to view 1 more bullet unable to bear weight after injury baseline functional status comorbidities Physical exam inspection login to view 2 more bullets palpation login to view 1 more bullet varus/valgus stress testing login to view 3 more bullets neurovascular exam login to view 3 more bullets Imaging Radiographs recommended views login to view 4 more bullets optional views login to view 2 more bullets findings login to view 8 more bullets CT scan indication login to view 3 more bullets findings login to view 6 more bullets MRI indications login to view 3 more bullets DIFFERENTIAL Distal femur fracture Knee dislocation Patella instability Patella fracture Patella tendon rupture Quadriceps tendon rupture ACL tear Meniscus tear Treatment Nonoperative closed reduction / immobilization login to view 9 more bullets Operative ORIF login to view 27 more bullets external fixation +/- limited fixation login to view 7 more bullets arthroplasty login to view 5 more bullets Techniques Closed reduction & Immobilization technique login to view 2 more bullets Provisional External Fixation technique login to view 5 more bullets advantages login to view 3 more bullets findings login to view 2 more bullets External Fixation with Limited Internal Fixation technique login to view 3 more bullets pros login to view 1 more bullet cons login to view 4 more bullets Open reduction internal fixation (ORIF) goals login to view 8 more bullets approach login to view 26 more bullets reduction login to view 18 more bullets internal fixation login to view 19 more bullets postoperative login to view 3 more bullets Complications Post-traumatic arthritis incidence login to view 2 more bullets risk factors for arthritis login to view 3 more bullets risk factors for future TKA login to view 3 more bullets Compartment syndrome incidence login to view 1 more bullet risk factors login to view 6 more bullets treatment login to view 1 more bullet Infection incidence login to view 1 more bullet risk factors login to view 3 more bullets reduced deep infection rates with intraoperative vancomycin powder application treatment login to view 4 more bullets Nonunion/malunion incidence login to view 2 more bullets risk factors login to view 3 more bullets treatment login to view 1 more bullet Knee stiffness incidence login to view 2 more bullets risk factors login to view 6 more bullets treatment login to view 2 more bullets Loss of reduction incidence login to view 1 more bullet risk factors login to view 3 more bullets treatment login to view 2 more bullets Deep vein thromobosis incidence login to view 2 more bullets Prognosis Mortality rate 5% at 1 year Return to work 70-90% at 1 year login to view 1 more bullet Mean ROM 10-145 degrees at 1 year