Tibial plateau fractures are one of the most common fractures in knee trauma. The upper end of the tibia forms the knee joint with the lower end of the femur. The surface in contact with the lower end of the femur is the tibial plateau, also two slightly concave surfaces, and there is a medial or lateral meniscus to enhance the concave surface, and the opposite surface of the femoral condyle to form a motion track, and increase the stability of the knee joint, the tibial plateau is an important loading structure of the knee, once a fracture occurs, so that the uneven force on the inner and outer plateau will produce osteoarthritic changes, due to the medial and lateral collateral ligaments on the inner side of the tibial plateau respectively, and the central part of the plateau has Due to the medial and lateral collateral ligaments of the tibial plateau, respectively, and the central tibial ramus with cross ligament attachment, damage to the ligaments and meniscus often occurs when the tibial plateau is fractured.
Fractures of the tibial plateau can be caused by indirect violence or direct violence. In a fall injury from a height, the foot lands first and then falls to the side, and the force is transmitted from the foot up along the tibia, and the acceleration of the fall causes the force of the weight to be transmitted downward, acting together on the knee, resulting in a collapsed fracture of the medial or lateral tibial plateau due to the torsional force generated by the lateral fall. When violence strikes the medial or lateral side of the knee directly, it causes the knee to externally or internally rotate, resulting in a lateral or medial plateau fracture or ligament injury.
Treatment of tibial plateau fractures is aimed at restoring the flatness of the articular surface and the integrity of the ligaments and maintaining knee motion. The tibial plateau is cancellous bone and is located within the joint. There are many different types of fractures, and no matter what treatment is used, it is difficult to absolutely restore the smoothness of the cartilage surface, and because the regenerative capacity of the injured cartilage is extremely low, osteoarthritic changes or poor joint stability are often left behind.
Typing
Tibial plateau fractures are common intra-articular fractures, and the type of fracture varies with the treatment and outcome. At the same time, in order to assess the treatment outcome, there is a need for uniformity and standardization of staging. The commonly used staging methods for tibial plateau fractures are AO staging and Schatzker staging.
The AO typing is detailed, which is extremely beneficial for accumulating information and facilitating the physician’s decision on the treatment plan. The AO typing of tibial plateau fractures includes partial intra-articular fractures (type B) and complete intra-articular fractures (type C), which are divided into two types and six groups of 18 subtypes.
Schematic diagram of AO fracture type B
41-B1, partial intra-articular fracture with simple splitting
41-B1, 1 lateral articular surface fracture
41-B1, 2 medial articular surface fracture
41-B1, 3 oblique fracture involving the tibial crest and one side of the articular surface [(1) lateral, (2) medial
41-B2, partial intra-articular fracture, simple compression
41-B2, 1 complete compression of the lateral articular surface
41-B2, 2 partial compression of the lateral articular surface
41-B2, 3 medial articular surface compression
41-B3, partial intra-articular fracture, splitting-compression
41-B3, 1 lateral articular surface
41-B3, 2 medial articular surface
41-3, 3 oblique fracture involving the tibial crest and one side of the articular surface [(1) lateral, (2) medial]
Schematic representation of AO fracture type C
41-C1, complete intra-articular fracture, simple fracture of the joint, simple fracture of the epiphysis
41-C1, 1 mildly displaced
41-C1, 2 unicondylar displacement
41-C1, 3 bicondylar displacement
41-C2, complete intra-articular fracture, simple fracture of the joint, comminuted epiphysis
41-C2, 1 complete wedge fracture [(1) lateral, (2) medial]
41-C2, 2 comminuted wedge fracture [(1) lateral, (2) medial
41-C2, 3 Complicated fracture
41-C3, complete intra-articular fracture, comminuted fracture of the joint!
41-C3, 1 lateral
41-C3, 2 medial
41-C3, 3 lateral plus medial