Tibial Plateau Fracture

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The tibial plateau is made of cancellous bone, which is much softer than the thicker bone lower in the tibia. An impact often causes the cancellous bone to compress and remain sunken. This damage to the tibial plateau may result in improper limb alignment, and over time can lead to arthritis, instability, and loss of motion in the affected knee.

Generally, the portion of the shinbone (tibia) that is closer to the knee has two relatively flat areas that support the thigh bone (femur) called the medial tibial plateau (inner) and the lateral tibial plateau (outer). The two areas help support the structures for the knee joint. When this portion of the knee becomes fractured, it is called a tibial plateau fracture.

A tibial plateau fracture is a fracture (or break) that is located in the upper part of the shinbone (tibia) which can result from a low-energy injury, such as a fall from a height, or a high-energy injury, such as a traumatic event. Moreover, there are three different types of tibial plateau fractures, which are:

  • Displaced tibial plateau fracture – A displaced fracture is where the bone breaks into multiple fragments. Usually, surgery is needed to help fix the fragments back in place. In situations where there was an open fracture, a ring-like metal brace called an external fixator may be used.
  • Non-displaced tibial plateau fracture – A non-displaced fracture is when the tibia sustains a break or crack without a fragment of the bone becoming separated. These normally have a better outcome than displaced fractures and can heal without surgical treatment within 3-4 months.
  • Double plateau fracture (medial and lateral) – For fractures that involve both tibial plateaus, there may be a chance of significant instability and displacement. Even if there is a minimal displacement caused by a fracture involving both tibial plateaus, surgical fixation may be recommended. Following surgical procedures, recovery may take a number of months and will require you not to weight bear for an extended period of time.
  • Single plateau fracture (medial or lateral) – Experiencing a fracture involving a single tibial plateau may cause deformity, which further treatment is required to repair the bone back in place.

Causes & Symptoms of a Tibial Plateau Fracture

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A tibial plateau fracture can occur in a few ways. One of the most common is from stress (small breaks from unusual excessive activity) or from a compromised bone (cancer or infection). In cases of the fracture, however, are the result of trauma: 

  • Low-energy trauma – This includes a fall from a height and / or sports-related trauma, such as a fall from running in a soccer match. Also, the upper tibia is also prone to becoming fractured in high-speed accidents such as those associated with skiing, horseback riding, and certain aquatic sports.
  • High-energy trauma – such as a motor vehicle collision in which leads you to an increased risk of fracturing or breaking a joint.

A fracture of the upper tibia may result in injuring both the bone and the soft tissues of the knee area. Therefore, symptoms of a tibial plateau fracture include:

  • Pain when any weight is applied

  • A cold sensation of the foot

  • Swelling that is noticeable

  • Deformity around the affected knee
  • Limited range of motion
  • “Pins and needles” in the foot (due to nerve damage)

Who gets a Tibial Plateau Fracture?

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Most conditions that are linked to tibial plateau pain include overuse injuries, meaning they occur over time through repeated use. Tibial plateau fractures happen most often in:

  • Age – Older patients ages 50 and up are more prone to experiencing tibial plateau fractures due to general wear and tear (degeneration).
  • Sports – Most athletes who play sporting activities that involve repetitive running and/or jumping are prone to fracturing their tibial plateau. Some of these include skiing, soccer, and basketball. Additionally, motocross is a sport that includes a high risk of trauma, which can lead to fractures in a joint.
  • Vehicle trauma – Experiencing a vehicle accident can lead to several conditions, whether it is whiplash, fractures, and even death.
  • Unsupportive footwear – Running shoes that do not provide enough cushion and support proper foot mechanics may encourage the development of shin pain, thus increasing the likelihood of a fracture.

How Does a Tibial Plateau Fracture Affect You? How Serious is it?

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In severe cases, severe swelling of soft tissue caused by tibial plateau fracture may cause a serious condition known as compartment syndrome to develop. Compartment syndrome can affect the blood supply to the muscles and nerves in the leg and foot.

Recommended Treatment & Rehabilitation for a Tibial Plateau Fracture

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A diagnosis of a tibial plateau fracture involves a regular three-step process that will help your doctor diagnose your condition. Firstly, he or she will ask you about your full medical history, perform physical examinations, and order additional imaging tests, such as computed tomography (CT) scan and magnetic resonance imaging (MRI).

This process will clarify what fractured your tibial plateau. Moreover, performing this diagnosis will help your doctor determine which type of tibial plateau fracture is present (known as a Schatzker classification), which will include the following types:

  • Type I – This is a type of fracture that appears as a wedge-shaped cleavage fracture and involves a vertical break of the lateral tibial plateau, usually the result of low-energy injury.
  • Type II – This type includes both cleavage and compression fracture and involves a vertical break of the lateral condyle combined with the impact of the opposite load-bearing part of the condyle.
  • Type III – This type of fracture involves a pure compression fracture of the lateral or central tibial plateau in which the articular surface of the tibial plateau is impacted and driven down into the lateral tibial metaphysis.
  • Type IV – In a medial tibial plateau fracture, a split or depressed component occurs, which is typically the result of a high-energy injury and involves a strong force loading at the knee.
  • Type V – Also known as a bicondylar tibial plateau fracture, it consists of a split fracture of the medial and lateral tibial plateau, which is usually the result of a high-energy injury acting upon the tibial plateau.
  • Type VI – In this type of fracture, a transverse subcondylar break with dissociation occurs.

The tibial plateau is an important joint that is needed to be repaired if fractured. In most severe cases, the fracture can turn into a full rupture if left untreated, which will require surgical treatment due to the broken bone. The main target of surgery for a tibial plateau fracture is to help restore the articular cartilage and ensure proper alignment.

Tibial plateau surgery is commonly executed with open reduction and internal fixation (ORIF). In more complex cases, fractures are oftentimes managed with external fixation followed by ORIF at a later time. After the surgery is finished, you may need to use additional equipment, such as a cane or walker.

Of course, all surgeries require incisions (cuts that allow surgeons to open an area of the body to make repairs). Therefore, this means there is a chance of complications that can become present along the way, such as:

  • Persistent knee pain – Some patients tend to continue to have persistent knee pain after surgery.
  • Long-term knee stiffness – Long-term stiffness is usually caused by excessive scar tissue. Oftentimes, lack of use or exercise can cause scar tissue to build up in the soft tissue around the joint.
  • Nerve or blood vessel damage – During surgery, there is a minimal chance that the nerves, veins, or tissue around your knee can be damaged. Damaged nerves or blood vessels can cause numbness, pain, or lower blood flow around the injured knee. Normally, any damage will heal on its own over time. In some cases, a procedure may be recommended to help fix the issue.
  • Blood clots – Because a tibial plateau surgery affects the way blood flows around your knee, it can increase your risk of developing blood clots.

After a diagnosis and any surgical procedure have been done, physiotherapy may be further advised. A physiotherapist will be able to design the following treatment plans and work with you to help recover after a tibial plateau surgery:

 

Range-of-motion exercises

Swelling and pain can make you move your knee less. Your physiotherapist can teach you safe and effective exercises to restore movement to your knee so that you can perform your daily activities the usual way.

 

Strengthening exercises

Weakness of the muscles of the thigh and lower leg could require you to use a cane when walking, even after you no longer need a walker or crutches after surgery. Your physiotherapist can determine which strengthening exercises are a good fit for you.

 

Balance training

When you are able to put your full weight on your knee without pain, your physiotherapist may add agility exercises and activities using a balance board that challenges your balance and knee control. Your program will be based on the physiotherapist’s examination of your knee, on your goals, and on your activity level and general health.

 

Functional training

When you can walk freely without pain, your physiotherapist may begin to add activities that you were doing before your knee pain started to limit you. These might include community-based actions, such as crossing a busy street or getting on and off an escalator.

Regular exercise to restore strength and mobility to your knee and a gradual return to everyday activities are important for your full recovery after your treatment. Here are some exercise examples to help relieve symptoms linked to tibial plateau fracture:

 

Thigh squeezes

Lie on your back, then, tighten the muscles in the front of your thigh by pushing the back of your knee down toward the floor or bed. Hold for 5 seconds and then release before repeating with 3 sets of 5-20 repetitions.

 

Straight let raises

Lie on your back and bend your uninjured knee so your foot is flat on the floor. Tighten your injured thigh and lift your straight leg to the height of your opposite knee. Lastly, hold for 2 seconds at the top and slowly lower back to the starting position. Repeat this exercise with 3 sets of 5-20 repetitions.

 

Knee bending

Sit in a stable chair and bend your knee back as far as possible. Then hold it for 5 seconds and then return it to the resting position. Repeat this stretch with 3 sets of 5-20 repetitions.

 

Clamshells

Lie on your side with the recovered knee pointed toward the ceiling. Next, keeping your heels together, open and close your legs like a clamshell. Repeat this with 3 sets of 5-20 repetitions.

Alternative & Homeopathic Treatment for a Tibial Plateau Fracture

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Some homeopathic and natural remedies are available to recover much sooner after your tibial plateau fracture. Some of these treatments include:

 

Avoid foods with vitamin K

If you received surgical treatment for your fracture tibial plateau, it is highly recommended to avoid eating foods that are high in vitamin K, as this enhances blood clotting. This can be useful for preventing bleeding, but keeping vitamin K amounts consistent after surgery is important.

Vitamin C and zinc

Your doctor may suggest that you supplement your diet with vitamin C and zinc. These two substances may help maintain your immune system. A healthy immune system is crucial while your wound is healing. There is also evidence that vitamin C may help prevent inflammation and joint damage in a natural knee.

Ice application

For pain and swelling, put ice or a cold pack on the area for 10-20 minutes at a time. Additionally, you can put a thin cloth between the ice and your skin for a recovery boost.

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