The exposure and fixation of the posterolateral column fracture was a difficult point of the surgery, and the treatment of the posterolateral tibial plateau fracture was very challenging 10, 11. Aug 09, 2016 management of tibial plateau fracture 1. This is a wedgeshaped pure cleavage fracture and involves a vertical split of the lateral tibial plateau. In 2007, we introduced a novel management protocol to treat tpfs which consisted of an angiosome or perforatorsparing aps anterolateral approach followed by unrestricted weight bearing and range. The tibial plateau fracture walter mak, md department of medical imaging st. A tibial plateau fracture is a bone fracture or break in a specific part of the tibia or shinbone called the tibial plateau. Consist of medial and lateral plateau medial larger medial lower concave medial bone harder thus less likely to fracture lateral higher convex lateral cartilage thicker 3 vs. Les fractures des plateaux tibiaux sont frequentes, et representent 1% des. According to recent series, tibial plateau fractures are most commonly the. Endstage arthritis following tibia plateau fractures. Arthroscopyassisted percutaneous fixation is the treatment of choice in schatzker types 1, 2, 3, and 4 fractures, as it ensures optimal reduction and stable fixation consistent with early mobilisation.
How ever, higher schatzker fracture rankings may rep resent fracture. Rehabilitation guidelines for tibial plateau fracture 4 p a g e cardiovascular exercises treadmill running, bike, ube progression criteria independent with hep passing score on return to sport test with low risk of reinjury reported return to sport references. Tibial plateau fractures remain a clinical challenge due to the complexity of the fracture patterns which have been repeatedly categorized by many researchers. Whats new in the management of complex tibial plateau. The schatzker classification system focuses on standard tibial plateau fractures. The schatzker classification system divides tibial plateau fractures into six types. Elevate the knee above the heart for the first 3 to 5 days. About me tibial plateau fracture tibial plateau fractures. The severity of the injury to the surrounding soft tissues influence the timing and the method of fixation. Imaging of knee injuries with special focus on tibial plateau. Does anticoagulation prevent thrombosis for persons with. A tibial plateau fracture involves the cartilage surface of. It is usually the result of a low energy injury in young individuals with normal mineralization. Intraarticular tibial plateau fractures request pdf.
The treatment of tibial plateau fractures in elderly patients is challenging, and the comprehension of epidemiology and morphology can be helpful. Therefore, we propose a change of attitude in the treatment of theses fractures. Dec 31, 2015 assessment and management of tibial plateau fractures for orthopaedic surgery residents. At present, there was no uniform standard for the surgical approach for the posterolateral column fracture of the tibial plateau. A tibial plateau fracture involves the cartilage surface of the knee joint. Introduction one of the most critical loadbearing areas in the human body. Ptpfs were found in 151 cases and had an incidence of 28. The context of the following recommendations is that kieran, prior to his accident, had undertaken regular exercise and was not overweight. Early detection and appropriate treatment of these fractures are critical for minimizing patient disability and reducing the risk of documented complications, particularly posttraumatic ar. Fractures of the tibial plateau is about 25% of tibial fractures, their exploration is essentially based on the ct and their treatment is usually surgical, so radiologist is asked to satisfy surgeons requirement. Fracture type iii fractures according to schatzker represents a central depression of the tibial plateau, often lateral tibial condyle. Maintain a high clinical suspicion for obtaining additional imaging or ct for patients unable to. All underwent venography approximately 9 days after fixation and were followed clinically for 6 weeks. The non surgical treatment was of frequent indication.
Les donnees cliniques et radiologiques ont ete colligees a 3, 6, 12 mois et au dernier recul amplitude articulaire, ikdc, hss, lysholm. The tibial plateau is one of the most critical loadbearing areas in the human body. Whats new in the management of complex tibial plateau fractures. The tibia is the major bone of the lower leg, commonly referred to as the shin bone.
The management of complex tibial plateau fractures is ever evolving. If the plateau is injured and the fracture is depressed, the femur will fall into the defect, and the knee will be unstable in the direction of the fracture. Orthopedics tibial plateau fractures have a variety of classifications, including those by hohl,1 moore,2 schatzker et al,3 and the ao system, 4 1 a, b, and c. Jan 26, 2020 the tibia is the major bone of the lower leg, commonly referred to as the shin bone. Maitrise orthopedique articles les fractures recentes des. The latter three fractures have been associated with an acl tear.
Tibial plateau fractures tpfs are challenging, requiring complex open reduction and internal fixation orif and are often associated with complications including surgical site infections ssis. Dec 06, 20 tibial plateau fractures by yasser alwabli slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Traitement des sequelles des fractures du plateau tibial d. The severity of symptoms depends on how it breaks, which is usually from a. Tibial plateau fractures orthopaedic trauma association. Parmi les differentes classifications des fractures des plateaux tibiaux, on distingue. Five hundred fourteen cases of tibial plateau fractures were enrolled. Posterior tibial plateau fracture ptpf was defined as a fracture with an independent fragment of the posterior column results. Apres loperation, le genou est immobilise par une attelle, et lappui est interdit pendant 45 a 90 jours. The major aim of this thesis was retrospectively to study imaging of knee injury with a special focus on tibial plateau fractures in patients referred to a levelone trauma center.
Journal of clinical medicine article a new approach to surgical management of tibial plateau fractures stuart a. Traitement des sequelles des fractures du plateau tibial. Once the plateau is fractured, the patient should be braced or splinted and placed on crutches. Post tibial plateau fracture osteoarthritis is common approximately onethird of all tibial plateau fractures due to the articular surface being involved, despite the age of the patient at the time of fracture. I suffered my tibial plateau fracture type iii on 05. Schatzker classification of tibial plateau fractures rsna. Dec 07, 2015 about 50% of tibial plateau fractures are associated with meniscal injuries, while ligament injuries can be found in up to 25% of cases4, 5, 6. Tibial plateau fracture treatment at kayal orthopaedic center. Had a tibial plateau fracture on shift the other day and all i really remembered from this was some tibial plateau fractures are really bad. Trauma total knee arthroplasty following tibial plateau fracture. Schatzker classification system is one method of classifying tibial plateau fractures increase in type number denotes increasing severity, reflecting an increase in energy imparted to the bone at the time of injury and also an increasingly worse prognosis 1. Tourne les fractures du plateau tibial, comme toute fracture articulaire, necessitent une reduction anatomique et une fixation stable et solide pour permettre une reeducation immediate.
Cette classification en six types des fractures du plateau tibial, dapparition plus. Tibial plateau fracture causes, symptoms and treatment. The overall incidence of dvt was 28% 40% with femoral shaft, 43% with tibial plateau, 22% with tibial shaft, and 12% with tibial plafond distal articular tibia. In some more complex cases, fractures can be managed by external fixation followed by further orif at a later time. Tibial plateau fracture phase i maximum protection 0 to 1 weeks. In counselling patients with tibial plateau fractures, an important topic to discuss is the longterm incidence of osteoarthritis. The severity of symptoms depends on how it breaks, which is usually from a traumatic injury or overuse injury. A new approach to surgical management of tibial plateau. A tibial plateau fracture is a bone fracture or break in the continuity of the bone occurring in the proximal upper part of the tibia shinbone. Fracture of the posterior part of the lateral tibial plateau ltp was seen in 11 patients, impacted fracture of the lateral femoral condyle lfc in two, lateral tibial rim fracture segond fracture in three, and avulsion fracture of the tibial attachment of the acl in two. Intraarticular fracture of a major weightbearing joint of the lower extremity, such as a tibial plateau fracture, is thought to carry an even higher risk. In june 2015 i was asked by fellow swimmer, kieran kelly, about the nutritional requirements of a person recovering from tibial plateau fracture and surgery. An overlooked fracture or delayed diagnosis can lead to poor patient outcome.
Tibial plateau fractures are commonly described as a combination of fractures affecting medial, lateral or both condyles in the sagittal plane. So, fractures of the plateau affect knee alignment, stability and motion. Tibia fractures can occur from many types of injuries. The prognosis of tibial plateau fractures directly depends on four factors. Apr 27, 2018 the tibia or shinbone is the most common long bone in the body for someone to fracture.
So we aimed to reclassify tibial plateau fractures based on injury mechanism and morphological characteristics. Its typically a low energy trauma on a weaker bone 4. Ice and modalities to reduce pain and inflammation. Tibial plateau fractures initial management guidelines. Tibial plateau fractures are the most common intraarticular fractures, which require careful evaluation and preoperative planning.
This type of fracture affects knee joint, stability and motion. A schatzker type i fracture is a wedgeshaped pure cleavage fracture of the lateral tibial plateau, originally defined as having less than 4 mm of. The tibial plateau is the top joint surface of the shinbone and is one of the most critical loadbearing areas in the human body. Restore joint congruity preserved normal mechanical axis sta. Assessment and management of tibial plateau fractures for orthopaedic surgery residents. Fracture of the posterior aspect of the lateral tibial. At present, there was no uniform standard for the surgical approach for the posterolateral column fracture of.
About 50% of tibial plateau fractures are associated with meniscal injuries, while ligament injuries can be found in up to 25% of cases4, 5, 6. Murphy wm 2000 ao principles of fracture management. Medical info tibial plateau fracture tibial plateau fractures. Reproducibility of three classifications schatzker, ao, duparc and a revised duparc classification. According to recent series, tibial plateau fractures are most commonly the result of falls or motor vehicle accidents.
Maintain a high clinical suspicion for obtaining additional imaging or ct for patients unable to bear weight in the ed following injury. Tibial plateau fractures can have subtle radiographic findings. Tibial plateau, fracture, epidemiology, osteoarthritis, surgery. Tibial plateau fractures result from 1 indirect coronal andor 2 direct axial compressive forces. A new approach to surgical management of tibial plateau fractures. Technical aspects on the surgical treatment of special tibial. Rockwood and greens fractures in adults philadelphia. Fracture tibial condyle, fracture tibial plateau, fracture of tibial plateau disorder, fracture of tibial plateau, fracture of tibial plateau nos, fracture tibia plateau, fracture tibial plateau, plateau tibial fracture, fractures plateau tibial, tibia fracture plateau. Tibial plateau fractures by yasser alwabli slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Basketball fans pondered the fate of kobe bryant after the lakers announced that the star player was out for the season with a lateral tibial plateau fracture. Ce mecanisme peut aussi donner une fracture du plateau tibial externe. Our purpose is to expose what a surgeon expects from the radiologist concerning a ct exam made for a.
This study described the characteristics of geriatric tibial plateau fractures. Tibia fractures come in different shapes and sizes, and each fracture must be treated with individual factors taken into account. The tibia or shinbone is the most common long bone in the body for someone to fracture. Jul 05, 2018 the tibial plateau is one of the most critical loadbearing areas in the human body. Schatzker classification for tibial plateau fracture. Schatzker classification of tibial plateau fractures. Arthroscopic management of tibial plateau fractures. Retrospective analysis of 514 cases of tibial plateau.
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