High Energy Tibial Plateau Fracture

Tibial Plateau Fractures

Fractures of the upper portion of the tibia which involve the joint surface are referred to as tibial plateau fractures. Like many other fractures, these run the spectrum from non-displaced, low energy injuries to high energy, severely displaced fractures.  If the joint surface is disrupted or incongruent then I will usually recommend surgical repair to realign and stabilize the fractures.  For the more severe injuries, I will place an external fixation device that spans the knee to allow the soft tissues around the knee time to “cool off”.  Some of the worst complications of these fractures occur when the surgical repair is performed too early and the soft tissue around the knee breaks down. Surgery focuses on realigning the joint surface and fixation with plates and screws. Surgery generally takes 2-3 hours and most patients spend 2-4 days in the hospital.  Most patients with tibial plateau fractures heal quickly but I keep most patients on crutches for the first 4-6 weeks after surgery. Pool therapy is very useful during this time as it allows for some motion without putting stress on the surgical repair. The biggest risk after surgery is blood clots in the veins of the legs and pelvis and I treat all patients with a medication called low molecular weight heparin for the first two weeks after surgery. After 6 weeks I allow patients to begin putting full weight on their leg and start more aggressive physical therapy. Full recovery for most femur fractures takes 6-8 months.  Many patients complain of irritation from the plate on the outer surface of the tibia and I often recommend removal of the plate after 12 months. This is a short outpatient surgery that usually takes about an hour to perform and the use of crutches or protected weight bearing after surgery is not indicated.

Tibial Plateau fractures repaired with plates and screws