Patients will present with sudden onset pain in the affected knee, being unable to weight-bear, and swelling of the knee*. A clear history of the mechanism of injury is important, as an injury through axial loading or high-impact injuries will increase the likelihood of a tibial plateau fracture. Patients will present following a history of trauma. Figure 1 - The tibial plateau Clinical Features * Complicated fractures include those demonstrating an articular step ≥2mm, angular deformity ≥10 degrees, any metaphyseal-diaphyseal translation, ligamentous injury requiring repair, or those with associated tibial fractures Postoperatively, a hinged knee brace is fitted with early passive range of movement but limited or non-weight bearing for around 8-12 weeks months is typically required.Įxternal fixation with delayed definitive surgery is indicated in cases of significant soft tissue injury, polytrauma and highly comminuted fractures where an immediate ORIF may not be suitable. Any metaphyseal gaps can be filled with bone graft or bone substitute. Open reduction and internal fixation (ORIF) is the mainstay of most tibial plateau fractures, with the aim to restore the joint surface congruence and ensure joint stability. Any form of medial tibial plateau fractures may also require surgical intervention, even if undisplaced, as they have a great potential for displacement. Operative management is typically warranted in complicated tibial plateau fractures*, or any evidence of open fracture or compartment syndrome. Figure 3 – CT imaging demonstrating lipohaemarthrosis due to a tibial plateau fracture Operative Management
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