The tibial plateau is the flat, expanded top of the shin bone or tibia which makes up the lower half of the knee joint. It is a very important part of the body for load bearing and any disruption of this area can cause abnormalities in alignment of the knee, knee stability and movement especially weight bearing and walking.

Early recognition and treatment of this injury is vital to avoid the potential disability which could ensue and the longer term consequences of knee arthritis. More than half the sufferers from this fracture are over fifty years of age.

Older women make up a significant proportion of patients with this fracture, related to the degree of osteoporosis present in this group. More energetic injuries present with this fracture in younger people.

When this fracture occurs, the usual method is for a downward force to be acting on the knee joint when it is suddenly pushed into a knock knee posture. Most commonly the outer condyle of the femur crushes down on the tibial condyle below it and presses the bone downwards into a fracture.

Motor vehicles injuries are a common reason for this presentation, with falls from a height and sporting injuries also figuring.

Around 25% of this kind of injury is secondary to a person being hit by a slow speed car at roughly the height of the knee joint, the bumper being the primary contact point. Falling from a height or sporting activities including horse riding can also result in this fracture.

A fracture may result from a low energy event or a high energy event, depression fractures being more common from lower energy contacts and splitting fractures more common in higher energy involvement. This type of fracture can present in many complex ways and Schatzker and co workers have proposed a classification into six subtypes which is widely used.

Patient assessment does not concentrate solely on the state of the bony structures but includes the soft tissues in the local area including nerves, muscles and blood vessels. Cruciate ligament and cartilage (meniscal) injuries accompany around half of the number of tibial plateau fractures and these may require separate surgical intervention.

The medial collateral ligament, on the inside of the knee joint, is more at risk from the injuring forces as they often hit the knee laterally and force it into a knock knee position. More severe events can fracture the medial plateau and this is accompanied by higher rates of soft tissue damage.

It may be appropriate to accept a number of fracture displacement types for non-operative or conservative treatment but if the fracture depression is over 5 millimetres it may be decided to raise up the depressed surface and place a bone graft under it.

If the fracture is an open one (with an open wound) then surgery will be required, as it will in cases of damage to the vascular system and in the case of the development of compartment syndrome. If the fracture is not severe then it should be treated conservatively and operation may be avoided, at least temporarily, in cases where extensive soft tissue damage threatens tissue integrity.

Once the diagnosis has been established treatment can be started and this can include treatments to reduce inflammation and swelling such as rest, immobilisation, local compression and elevation of the leg. Cutting away any dead or dying tissues, a procedure known as debridement, is very important to maintain the health of the remaining viable tissues.

If there is any sign of inappropriately high pressure developing in part of the leg, known as compartment syndrome, the treatment is immediate fasciotomy by opening of the tissue compartments.

Tibial plateau fractures have as a treatment strategy to restore alignment of the knee joint, re-establish full range of movement, and ensure stability of the knee and anatomical alignment. Overall the knee should be painless, movable and free from arthritis.

Strong immobilisation of the fracture by surgery is necessary in unstable joints, with the denser bone of younger people allowing this. Functional bracing and total knee replacement may be necessary in older patients who have reduced bone density.

Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapy, back pain, orthopaedic conditions, neck pain, injury management and physiotherapists in Oxford. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.

Article Source:http://www.articlesbase.com/health-articles/tibial-plateau-fractures-1585076.html

Tags: Sports Medicine, tibial plateau, Seniors, knee stability, energy involvement, soft tissues

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