Tibial Plateau Fracture: Features, Classification and Treatment  

Tibial plateau fracture is a high-energy trauma fracture that affects your topside of the shin bone at the knee, which includes the cartilage surface of the joint. It may happen as a major road accident or a severe fall from a certain height. Elderly people are less likely to have such a fracture but may have it when falling from a height, especially in those who have osteoporosis.

This joint provides support to your body weight and when fractured it’s unable to handle stress or shock. That is why the person affected by a tibial plateau fracture is advised to stay away from pulling weight over that leg while recovering from the injury.  

Let us discuss how it feels to be in a tibial plateau fracture and how it is diagnosed.

Clinical features

The person may have a series history of trauma, like a complete history of the mechanism of the injury. And a history of injury is important because an axial loading or high-impact injury will increase the probability of the fracture. 

The affected individuals may feel a sudden onset of pain in the injured knee along with swelling of the knee followed by the inability to wear weights. 

However, on the specific diagnosis, swelling may be evident in addition to tenderness over medial or lateral attributes of the proximal tibia accompanied by ligament instability. 

Also, there should be an assurance to check the neurovascular status of the affected individual, as neurovascular injuries can also contribute to high-grade injuries. 

Other aspects of diagnosis 

While a patient is complaining of knee pain following trauma, other distinct characteristics to consider are knee dislocation, some other knee fractures, meniscal injuries, patella dislocation, ligamentous injuries, or patella/quadriceps tendon rupture. 

Causes 

As we have discussed, a tibial plateau fracture is an outcome of a severe injury or trauma to the leg. 

In short, we can say the fracture may be caused due to:-

  • Falling from height 
  • A severe road or motor vehicle accident 
  • Sports injuries, such as football or skiing

Alongside these causes, other risk factors also include osteoporosis, a mineral deficiency that tends to weaken the bones and make them more fragile towards injuries. 

Symptoms 

Usually, a fracture causes intense discomfort in your affected part. A tibial plateau fracture causes discomfort in or over your shin bone, from impact. People struggle to bend the knee after a tibial plateau fracture, and only a limited bending can be achieved.  

Also read: What causes fibromyalgia|symptoms, diagnosis, treatment 

The related signs of tibial plateau fracture are:- 

  • Trouble bearing weight on your leg
  • Swelling and tenderness at the knee
  • A paled leg due to decreased blood flow
  • Joint pain with or without bearing weight
  • Bone breaking via skin

The respective damages can be properly diagnosed with certain imaging tests like X-ray, MRI, or CT scan. 

Classification 

Tibial plateau fracture are categorized into the following types through Schatzker classification

Fracture type Description 
Type 1 Lateral split fracture
Type 2 Lateral split – depressed fracture
Type 3 Lateral pure depression fracture (rare)
Type 4 Medial plateau fracture
Type 5 Bicondylar fracture (rare)
Type 6 Metaphyseal – diaphyseal disassociation

Tibial plateau fracture recovery 

Well, recovery has no specific time in case of fractures, it can vary from a few weeks to a few months. As in the case of tibial plateau fracture, it will depend on the type of surgery that is being performed, and luckily surgery is not required in most cases but if there is displacement surgery will be the only option. 

Otherwise, a non-displaced tibial fracture will take 3-4 months to heal without the need for surgery. The healing after surgery may take one to two more months to get well. 

A complete treatment isn’t a surgery alone, but even after the surgery, the physical therapy continues for up to 6 months while a person is recovering from the fracture and have to follow few instructions by the therapist to do certain things in limitations. 

The duration of healing however varies according to a person’s body type and on the severity of the fracture. 

Treatment 

Tibial plateau fracture treatment depends on its classification. For instance, there are two types of fracture one is surgical and another one is non-surgical. So, the treatment for a non-surgical fracture will include:-

  • Rest your knee 
  • Splinting your knee and avoid pulling weight to protect the joints from any further damage 
  • Take pain killers 
  • Take cold compression and keep your extremities higher while the bone heals

And in surgical treatments, your doctor will use screws and plates to re-align the bone. Also, a study from 2013 shows that surgical treatments are effective in restoring knee function. 

Complications 

The complication included in the tibial fracture is post-traumatic arthritis to the affected leg. 

The factors contributing to the potential post-traumatic arthritis are:-

  • Axial misalignment
  • Meniscectomy during surgery
  • Intra-articular infection
  • Joint instability

Conclusion 

A tibial plateau fracture is the kind of fracture that affects the top of your shin bone which is over a cartilage surface. During the phase of fracture, you will feel intense pain and swelling at the affected site, with the inability to bend your knees and pull weight. The possible causes can be falling from a height, meeting a road or vehicle accident, and having osteoporosis in elderly patients which makes their joints more fragile and may fracture easily under some conditions. Consult your doctor for the appropriate treatment and avoid pulling weights and heavy workouts for a few months.  

Frequently Asked Questions 

 

How long does it take to recover from a tibial plateau fracture?

It may take up to 3-4 months to treat a non-surgical tibial fracture and can vary according to the improvement of the patient. While in surgical tibial fracture recovery may take more time, moreover the physical therapy takes 6 months for the final recovery even after the treatment, and the affected individual is advised to follow instructions for not pulling weight and do any physically involved work until the course of treatment. 

Is a tibial plateau fracture serious?

In short, tibial plateau fractures are really serious that damage the soft tissues of your joint. However, the treatment varies according to the type of tibial fracture as schatzker classified. Different types of treatment such as surgical or non-surgical are recommended according to the loss. Minimally invasive osteosynthesis is recommended in partial articular fractures when possible.  

What is the treatment for a tibial plateau fracture?

The treatment for a displaced tibial fracture usually involves metal plates and screws which are placed through a large incision. The type of fracture generally tells how many plates and screws are needed. At times, bone grafts or bone cement are used to support the joint. That’s it for the surgical treatment. But when the loss isn’t big and there is no displacement of the bone, simple home techniques might work without any surgery. 

How long is non weight bearing after tibial plateau fracture?

As per the standard aftercare for surgical treatment of tibial fracture patients is to not bear weight or only bear weight when necessary for 10-12 weeks straight. 

What happens if you walk on a tibial plateau fracture?

Athletes dealing with tibial fracture often complain of pain, swelling, and inability to move or bend the leg. The main issue is swelling, which compresses the nerves and blood vessels inside of your knee joint. This condition is called compartment syndrome, which can lead to the death of tissues. 

 How do you sleep with a tibial plateau fracture?

You can use a specialized pillow, such as a body pillow for elevation and keep the broken bone over your heart, it will prevent blood from causing swelling and pooling. Try to sleep on your back first while holding up on a few pillows, if it doesn’t work you can switch to a side position if possible. 

Can I bend my knee after tibial plateau fracture?

Yes, you can walk and bend knees after tibial fracture, but up to tolerance and above it you will feel strained. You couldn’t walk or bend your legs for a few days after your injury. Gradually you will be able to bend your knees and walk. Use your crunches for a few days until you aren’t recovered enough. 

Do Broken bones hurt more night?

Usually, bone injuries occur due to several reasons and increased physical activity and overuse are the common causes of so. And under-recovery and circumstances the bone is not able to carry on with required adaptations. However, the pain is worse while putting weight over it or more when resting. The pain feels more while resting such as at night, due to different reasons. One of those reasons may be the lower production of the anti-inflammatory hormone during the night and another one is staying in a position that can stiff the joints. 

Does pain make you sleep more?

Yes, the emotional and physical energy you spend while dealing with the pain may cause you fatigue and you feel sleepy, or either the excessive pain may cause you sleeplessness depending on several considerations. You may also feel sleepy due to the medications you are taking. So, it may happen or not that you will get good sleep during pain. 

What drugs that relieve pain and often induce sleep?

The class of medicine benzodiazepines helps in relieving pain and induce sleep. 

The medicines include:-

  • Diazepam, valium
  • Lorazepam, ativan
  • Flurazepam
  • Clonazepam, petril
  • Temazepam, restoril 

 

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