| The expansion of the flat upper end of the tibia | | | | number of tibial plateau fractures and these may |
| which makes up the distal half of the knee joint is | | | | require separate surgical intervention. The medial |
| known as the tibial plateau. The plateau is an essential | | | | collateral ligament, on the inside of the knee joint, is |
| part of the weight bearing function of the knee joint | | | | more at risk from the injuring forces as they often |
| and if compromised can severely affect the | | | | hit the knee laterally and force it into a knock knee |
| movement, stability and alignment of the knee, | | | | position. More severe events can fracture the medial |
| interfering with gait. The fracture should be | | | | plateau and this is accompanied by higher rates of |
| recognised early and treated accordingly so that the | | | | soft tissue damage. |
| chances of post-traumatic knee arthritis and disability | | | | It may be appropriate to accept a number of |
| are minimised. Over half the patients in this category | | | | fracture displacement types for non-operative or |
| are in their fifties or older. | | | | conservative treatment but if the fracture depression |
| A large group which suffer this type of fracture is | | | | is over 5 millimetres it may be decided to raise up the |
| older women who already have some degrees of | | | | depressed surface and place a bone graft under it. If |
| osteoporotic change in the area. Younger people with | | | | the fracture is an open one (with an open wound) |
| this presentation more likely result from more high | | | | then surgery will be required, as it will in cases of |
| energy events. The usual way these fractures occur | | | | damage to the vascular system and in the case of |
| is for a sideways force to be applied to the knee | | | | the development of compartment syndrome. If the |
| (often in a knock knee direction) while the knee is | | | | fracture is not severe then it should be treated |
| weight bearing with a downward force also applied. | | | | conservatively and operation may be avoided, at |
| The lateral condyle (most commonly) is then | | | | least temporarily, in cases where extensive soft |
| squashed down by the large femoral condyle on that | | | | tissue damage threatens tissue integrity. |
| side. Sports injuries and falling from a height can | | | | On establishing the diagnoses the management plan |
| result in this injury but it is much more common | | | | can begin and this includes treatments aimed at |
| secondary to a road accident. | | | | limiting swelling and inflammation such as keeping the |
| Around 25% of this kind of injury is secondary to a | | | | part still, resting, elevating the leg and compression of |
| person being hit by a slow speed car at roughly the | | | | the area. Debridement, the surgical removal of any |
| height of the knee joint, the bumper being the | | | | dying or dead tissue, is essential to ensure the well |
| primary contact point. Falling from a height or sporting | | | | being of the remaining healthy tissue. Compartment |
| activities including horse riding can also result in this | | | | syndrome, where higher and higher pressures |
| fracture. A fracture may result from a low energy | | | | develop in the leg compartments, is an emergency |
| event or a high energy event, depression fractures | | | | for which fasciotomy (surgical release of the tissues) |
| being more common from lower energy contacts and | | | | is indicated. |
| splitting fractures more common in higher energy | | | | Tibial plateau fractures have as a treatment strategy |
| involvement. This type of fracture can present in | | | | to restore alignment of the knee joint, re-establish full |
| many complex ways and Schatzker and co workers | | | | range of movement, and ensure stability of the knee |
| have proposed a classification into six subtypes which | | | | and anatomical alignment. Overall the knee should be |
| is widely used. | | | | painless, movable and free from arthritis. Strong |
| Patient assessment does not concentrate solely on | | | | immobilisation of the fracture by surgery is necessary |
| the state of the bony structures but includes the | | | | in unstable joints, with the denser bone of younger |
| soft tissues in the local area including nerves, muscles | | | | people allowing this. Functional bracing and total knee |
| and blood vessels. Cruciate ligament and cartilage | | | | replacement may be necessary in older patients who |
| (meniscal) injuries accompany around half of the | | | | have reduced bone density. |