Treatment strategy for tibial plateau fractures: an update

Abstract

Tibial plateau fractures are complex injuries produced by high- or low-energy trauma. They principally affect young adults or the ‘third age’ population.These fractures usually have associated soft-tissue lesions that will affect their treatment. Sequential (staged) treatment (external fixation followed by definitive osteosynthesis) is recommended in more complex fracture patterns. But one should remember that any type of tibial plateau fracture can present with soft-tissue complications.Typically the Schatzker or AO/OTA classification is used, but the concept of the proximal tibia as a three-column structure and the detailed study of the posteromedial and posterolateral fragment morphology has changed its treatment strategy.Limb alignment and articular surface restoration, allowing early knee motion, are the main goals of surgical treatment. Partially articular factures can be treated by minimally-invasive methods and arthroscopy is useful to assist and control the fracture reduction and to treat intra-articular soft-tissue injuries.Open reduction and internal fixation (ORIF) is the gold standard treatment for these fractures. Complex articular fractures can be treated by ring external fixators and minimally-invasive osteosynthesis (EFMO) or by ORIF. EFMO can be related to suboptimal articular reduction; however, outcome analysis shows results that are equal to, or even superior to, ORIF. The ORIF strategy should also include the optimal reduction of the articular surface.Anterolateral and anteromedial surgical approaches do not permit adequate reduction and fixation of posterolateral and posteromedial fragments. To achieve this, it is necessary to reduce and fix them through specific posterolateral or posteromedial approaches that allow optimal reduction and plate/screw placement.Some authors have also suggested that primary total knee arthroplasty could be an option in specific patients and with specific fracture patterns.Cite this article: Prat-Fabregat S, Camacho-Carrasco P. Treatment strategy for tibial plateau fractures: an update. EFORT Open Rev 2016;1:225-232. DOI: 10.1302/2058-5241.1.000031.

Total Knee Arthroplasty versus Osteochondral Allograft: Prevalence and Risk Factors following Tibial Plateau Fractures

“…1,2 For those treated surgically, treatment goals include restoring the articular surface plateau width and mechanical axes while achieving stable fixation to allow for early range of motion. [3][4][5] Despite these strategies, the longterm outcomes remain guarded for tibial plateau fractures: up to 45% of patients may develop posttraumatic arthritis (PTOA). [6][7][8] Traditional treatment options for patients with PTOA include osteotomy, arthrodesis, and total knee arthroplasty (TKA); however, in the majority of patients with end-stage osteoarthritis TKA is the primary option.…”

Tibial plateau fractures in elderly people: an institutional retrospective study

“…Because both classifications provide only two-dimensional information of the fracture, a CT-based three-column classification (TCC) would be a good supplement for evaluation [8]. There were already numerous studies which indicated that implementation of the three-column classification (TCC) might improve the surgical outcome of cases of TPFs [9, 10]. This is the first time that the TCC has been used to evaluate the morphological features of tibial plateau fractures in a large sample size of elderly patients.…”

Age-Related Variances in Patients with Tibial Plateau Fractures

“…However, the goals of surgical intervention remain the same: restoring the articular congruity, condylar width, and re-establishing limb mechanical alignment. [4][5][6]24 Absolute indications for surgical fixation of tibial plateau fractures include open injuries, compartment syndrome, and injuries with vascular disruption. Relative indications include articular step-off of !…”