TIBIAL PLATEAU FRACTURES

TIBIAL PLATEAU FRACTURES

Introduction

tibia and fibula

The tibia and fibula are the the bones of the leg which extended from the knee above to ankle below the tibia is more big than fibula the tibia is the medial bone but fibula is lateral one the tibia has shaft upper and lower end it is alone articulates with the femur at the knee joint the upper end has medial and lateral condyles the tuberosity of the tibia is at upper end of the anterior border of the shaft and gives attachment to the ligamentum patella the shaft of the tibia is lies subcutaneous so lacerations over it heal poorly because of lack of vascularity in the subcutaneous tissues as only the periosteum supports the skin the lower end of the tibia has the medial malleolus the
inferior surface of the of the lower end of the tibia is smooth and forms with the malleloi the upper surface of the ankle joint

 the fiblua is a long and thin bone has shaft upper and lower end and small head at it is upper end and has lateral melleolus at it is lower end the head of the upper end of the fibula articulate with the tibia below the head their is the neck around which winds the common peroneal nerve and damage to the nerve at this point as in fractures of the neck of the fibula or tight below knee plaster will result in foot drop

 TIBIAL PLATEAU FRACTURES

 

Tibial plateau fractures involve the articular surface of the proximal tibia (lateral and medial) tibial plateau

 lateral tibial plateau fractures  more common than medial tibial plateau fractures

Causes

these fractures occur when the knee experiences a varus or valgus force with or without a combined action or compression force

lateral plateau fractures usually occur from a direct blow  or force directed from the lateral side with a valgus force or secondary to impaction of lateral femoral condyle on plateau during severe valgus force abducting the tibia

what are the results of increasing force on the lateral tibial plateau

Tibial fragment depressed 1-  2- associated fibula neck fracture 3- rupture of medial collateral ligament 4- rupture of cruciates 5- subluxation of tibia 6- crushing lateral meniscus 7- conversion to bicondylar fracture

in lateral tibial plateau fractures the anterior tibial artery may be damaged this may result in necrosis of the anterior compartment muscles

 medial tibial plateau fractures may assciated with lateral ligament ruptures and common peroneal nerve palsy

Clinical pictures

Haemarthrosis - lateral or medial bruising - valgus or varus deformity of the knee so cross swelling and bruising with visible deformity gives an indication of the likely fracture configuration

may associated with lacerated skin or soft tissues and connected with exterior as open fractures

may associated with common peroneal nerve plasy lead to foot drop 

Investigations

plain X rays very helpful if these do not allow a clear understanding of the fracture pattern a CT scan is required

Treatment

 the aim of treatment  are to restore the articular surface maintain alignment of the articular surface with the rest of the leg and to resume early range of motion exercise

 non surgical treatment 

consists of short term of immobilization with a long leg cast followed by bracing or immediate cast bracing with delayed weight bearing for 8 week and full weight bearing after 3 months  if loss of reduction during the non surgical period surgical intervention is recommended to prevent malunion and unacceptable alignment

for undisplaced fractures with no ligament damage or tibial subluxation may use skin traction if there is less than 2 mm of displcament no reduction is needed 

surgical treatment

open reduction and internal fixation(ORIF) and bone grafting  and ligament repair 1- plating for unicondylar plateau fractures with antomic reduction of the articular surface 2- double plating for bicondylar fractures since the bicondylar fractures are often associated with large soft tissue contusions and excessive swelling so definite reconstruction should be delayed untill soft tissue envelope has stabilised and swelling is minimal during this period the patient can be treated by splint skeletal traction or spanning external fixator

Complications

as any fractures complications beside there is may associated with delayed wound healing due to compromised skin vascularity - limb malalignmentdue to fracture collapse - post traumatic arthritis - malunion - nonunion

 

tags:plateau,tibial,fractures