Tibial plateau fracture

Clinical presentation

Tibial plateau fracture are periarticular fractures of the proximal tibia often associated with soft tissue injury. Mechanism often involves a varus/valgus/axial load on the knee of varying degree of energy. Other associated injuries include meniscal tears, ACL injuries, compartment syndrome, open fractures and neurovascular injuries.

Clinical evaluation

It is important to look for:

• open injuries (i.e. any open wounds near fracture site)

• compartment syndrome (severe pain on passive toe extension despite analgesia)

• neurological deficits (particularly peroneal nerve)

• vascular injuries (must do ABPI if suspected)

Initial AP and lateral knee X Rays can identify most fractures. Note that negative radiographs with high index of suspicion for tibial plateau fracture should be investigated with CT scan. Some subtle x ray features include lipohaemarthrosis (fat / fluid level on lateral), and depressed joint surface. (learn more about Knee x ray interpretation)

Confirmed fracture on XR often require CT scan to assess the fracture pattern and articular congruity.

Most of these fractures require surgical fixation (to restore articular surface), but completely undisplaced fractures (or nonambulatory patients) may be managed non-operatively.

A&E management

1. provide analgesia

2. above knee backslab

3. elevate leg

4. refer to ortho oncall