Tibial Plateau Fracture : proximal part of the tibia is known as Plateau or Plateau. The tibial plateau has a slight posterior inclination (10°) and consists of 2 condyles (plateaus). The upper face of each condyle is large, ovoid and smooth.
The lateral plateau is covered by 4mm of cartilage. It is higher than the medial plateau and is convex.
The medial plateau is covered by 3mm of cartilage. It is wider than the lateral and is concave.
What is the function of the Tibial Plateau? The Plateau, next to the femur, forms the knee joint. That is, the integrity of the plateau is fundamental for knee function, such as flexion and extension, a fundamental movement for us to walk normally. In addition, many structures are inserted in the plateau, such as the cruciate ligaments of the knee (ACL and PCL), menisci and some other ligaments and tendons.
High-energy traumas generate commutive fractures (with many fragments), such as high-height falls on the extended knee. Fractures in the elderly have a more predominance of sinking of the plateau into the tibia.
What are the symptoms? Pain and edema (swelling) of the knee, in addition to inability to support body weight. Hemthrosis (joint effusion) is a very common sign. The presence of blisters, compartment syndrome (increased pressure inside the leg) and bone exposure (open fracture) may also be present and inspire greater care.
How is the diagnosis made? In addition to the clinical history and physical examination, the use of some imaging tests helps in the diagnosis and planning of the therapeutic approach. Radiography (X-ray) is the most accessible examination and the most used for this purpose. Tomography is very useful for a better evaluation of the fracture pattern. The mri, which is less used in cases of fracture, helps in the suspicion of soft tissue injuries, menisci and ligaments. Arteriography and ct angiography are useful in suspected arterial injury.
Are all fractures the same or is there any more serious than others? Plateau fractures differ in severity.
How is the fracture pattern classified? Although each fracture is different from one person to another, many have similar patterns. Such standards allow us to create a classification that guides physicians in the conduct of treatment.
Conservative treatment is usually indicated in fractures with little deviation (2 mm), closed fracture, without compartment syndrome and without vascular injury. It basically consists of the use of orthosis and load restrictions. The orthosis should be maintained until the 3rd week and progressive movement should be started, remaining for up to 8 to 12 weeks without load.
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Dr. Herberton Araújo
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