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Tibial Plateau Fracture Treatment Options
Fracture of the tibial plateau affects knee alignment, stability and movement. Early detection and appropriate treatment of tibial plateau fractures are critical for minimising damage to the knee and reducing the risk of further complications such as osteoarthritis.
Treatment is aimed at achieving a stable, aligned, mobile and painless joint as well as minimising the risk of post-traumatic osteoarthritis following the fracture.
Conservative treatment options involve immobilisation in an above knee plaster cast or a brace with a period where no weight baring is allowed. This period can vary from eight weeks to a few months or untill evidence of fracture union is shown on x-ray. However, this method of treatment is becoming less favourable by both clinicians and patients due to the prolonged period of immobilisation involved.
Surgical options involve and open reduction and internal fixation surgery. This is often a two-part surgery where the broken bone is first reduced (put back into place) followed by an internal fixation device placed on the bone. This can be achieved using screws, plates, rods or pins to hold the broken bone together.
This is an appropriate course of action for patients with joint depression, open fracture, neurovascular injury and compartment syndrome.
There are two main approaches taken when performing this surgery; anterolateral and posteromedial.
However, after extensive review of the literature and prolonged experience with various operative techniques used to fix different types of tibial plateau fractures Professor Munjed Al Muderis has developed his preferred method to fix any kind of tibial plateau fracture. This technique utilises arthroscopic technology (key hole surgery) to visualise the fracture and secure its accurate reduction, followed by internal fixation using a pre-contoured periarticular plate via a minimally invasive (small incision) technique.
Advantages of this minimally invasive technique compared to traditional anterolateral and posteromedial techniques include:
- Allows for accurate reduction of the fracture. This is due to the arthroscopic camera which provides direct visualisation of all injured structures including intra-articular soft tissues, both menisci and the cruciate ligaments
- Minimises the soft tissue dissection which preserves the vital blood supply to the injured tissue
- Does not cause any complications for potential future surgery such as a total knee replacement, if such surgery is required down the track. This is a result of the minimal scar in this approach which is far away from the midline. The midline is where the standard incision for total knee replacement is usually. However, the traditional anterolateral incision favoured in traditional tibial plateau fracture surgery could compromise the possibility of making a future midline incision since the skin bridge is very narrow and could compromise the blood supply to the flap that is created by the two incisions.
- Allows for treatment of any meniscal tears at the same time of fracture fixation
- Minimises the exposure area which decreases the chance of wound infection
- Reduces surgical time
- Faster rehabilitation and restoration of range of movement, with partial weight baring allowed from day one post-surgery
- No need for cast or bracing in the vast majority of cases
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