Acta Chir Orthop Traumatol Cech. 2009; 76(5):363-373 | DOI: 10.55095/achot2009/071

Current Concepts in Tibial Plateau FracturesCurrent concepts review

CH. THOMAS1,2, A. ATHANASIOV1, M. WULLSCHLEGER1,2, M. SCHUETZ1,2,*
1 Princess Alexandra Hospital, Brisbane, Australia
2 Orthopaedic and Trauma Queensland, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Brisbane, Australia

Tibial plateau fractures can range from a simple lateral split pattern to very complex bicondylar injuries that can be a source of great disability. these fractures can provide a challenge for both junior as well as for senior surgeons alike. careful evaluation of the mechanism of injury and fracture pattern plays a crucial part in the operative planning. Assessment of the soft tissues shoul be performed carefully and adequate imaging is mandatory to allow a more detailed evaluation of the fracture architecture and pre-operativeplanning. Timely accurate reduction and fixation is the goal. Over the last decade the surgical approach chosen has been largely determined by the fracture pattern. Internal plate osteosynthesis through antero-lateral and postero-medial incisions is the most commonly utilised technique for complex bi-condylar fractures. An early range of motion with special attention to full knee extension is essential for a successful functional outcome. Application of the principles mentioned is a pre-requisite to achieve the best result. New fixation techniques, such as locking plates, have not changed those principles but helped to apply them more reliably.

Published: October 1, 2009  Show citation

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THOMAS C, ATHANASIOV A, WULLSCHLEGER M, SCHUETZ M. Current Concepts in Tibial Plateau Fractures. Acta Chir Orthop Traumatol Cech. 2009;76(5):363-373. doi: 10.55095/achot2009/071. PubMed PMID: 19912699.
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References

  1. ALI, A. M., YANG, L., HASHMI, M., SALEH, M.: Bicondylar tibial plateau fractures managed with the Sheffield Hybrid Fixator. Biomechanical study and operative technique. Injury, 32, Suppl. 4:SD86-91.
  2. AO website: http://www.aofoundation.org
  3. BAREI, D. P., NORK, S. E., MILLS, W. J., et al.: Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique. J. Orthop. Trauma, 18:649-57, 2004. Go to original source... Go to PubMed...
  4. BAREI, D. P., NORK, S, E., MILLS, W. J. et al. Functional outcomes of severe bicondylar tibial plateau fractures treated with dual incisions and medial and lateral plates. J. Bone Jt Surg., 88-A:1713-21, 2006. Go to original source... Go to PubMed...
  5. BENNETT, W. F., BROWNER, B.: Tibial plateau fractures: a study of associated soft tissue injuries. J. Orthop. Trauma, 8:183-8, 1994. Go to original source... Go to PubMed...
  6. COLE, P. A., ZLOWODZKI, M., KREGOR, P. J.: Less Invasive Stabilization System (LISS) for fractures of the proximal tibia: indications, surgical technique and preliminary results of the UMC Clinical Trial. Injury, 34 Suppl 1:A16-29, 2003. Go to original source... Go to PubMed...
  7. EBRAHEIM, N. A., SABRY, F. F., HAMAN, S. P.: Open reduction and internal Fixation of 117 tibial plateau fractures. Orthopaedics, 27:1281-1288, 2004. Go to original source... Go to PubMed...
  8. EGOL, K. A., TEJWANI, N. C., CAPLA, E. L. et al.: Staged management of high-energy proximal tibia fractures (OTA types 41): the results of a prospective, standardized protocol. J. Orthop. Trauma, 19:448-55, 2005. Go to original source... Go to PubMed...
  9. GUSTILO, R. B., ANDERSON, J. T.: Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyss. J. Bone Jt Surg., 58-A:453-8, 1976. Go to original source...
  10. GUSTILO, R. B., MENDOZA, R. M., WILLIAMS, D. N.: Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J. Trauma, 24:742-6, 1984. Go to original source... Go to PubMed...
  11. KENNEDY, J. C., BAILEY, W. H.: Experimental tibial plateau fractures. J. Bone Jt Surg., 50:1522-34, 1968. Go to original source...
  12. LOBENHOFFER, P., GALLA, M.: The direct, dorsal approach to the treatment of unstable tibial postero-medial fracture-dislocations. Unfallchirurg, 106:241-7, 2003. Go to original source... Go to PubMed...
  13. LOBENHOFFER, P., GERICH, T., BERTRAM, T.: Particular postero-medial and postero-lateral approaches for the treatment of tibial head fractures. Unfallchirurg, 100:957-67, 1997. Go to original source... Go to PubMed...
  14. MOORE, T. M.: Fracture-dislocation of the knee. Clin. Orthop., 156:128-40, 1981. Go to original source...
  15. MOORE, T. M., PATZAKIS, M. J., HARVEY, J. P.: Tibial plateau fractures: definition, demographics, treatment rationale, and long-term results of closed traction management operative reduction. J. Orthop. Trauma, 1:97-119, 1987. Go to original source... Go to PubMed...
  16. MÜLLER, M. E., ALLGOWER, M., SCHNEIDER, R., WILLENEGGER, H.: Manual of Internal Fixation, 3rd edn. Springer, Berlin Heidelberg, New York, Springer 1999, 142-143.
  17. PERREN, S. M.: Fracture healing. the evolution of our understanding. Acta Chir. orthop. Traum. èech., 75:241-246, 2008. Go to original source...
  18. ROCKWOOD, C. A., GREEN, D. A., BUCHOLZ, R. W.: Fractures. Philadelphia, Lippincott 1991.
  19. SCHATZKER, J., McBROOM, R., BRUCE, D.: The tibial plateau fracture. The Toronto experience 1968-1975. Clin. Orthop., 138:94-104, 1979.
  20. SHEPHERD, L., ABDOLLAHI, K., LEE, J., VANGSNESS, C. T., Jr.: The prevalence of soft tissue injuries in nonoperative tibial plateau fractures as determined by magnetic resonance imaging. J. Orthop. Trauma, 16:628-31, 1999. Go to original source... Go to PubMed...
  21. ZIRAN, B. H., HOOKS, B., PESANTEZ, R.: Complex fractures of the tibial plateau. J. Knee Surg., 20:67-77, 2007. Go to original source... Go to PubMed...