Tibial Plateau Fracture

An AP knee radiograph shows a fracture of the lateral tibial plateau (arrows) in an osteopenic patient who had a recent trauma.

Facts

• Fractures involving the articular surface of the proximal tibia. This is a diverse group of fractures, a spectrum of different severity of injuries
• Most common mechanism of injury is fall with knee forced into valgus or varus
• Imaging performed to locate the fracture, identify fracture pattern and degrees of displacement
• Most common location = lateral tibial plateau
• Aim of surgical treatment is to restore or preserve limb alignment

Imaging

• Usually AP and lateral views of the knee show the fracture but bilateral oblique views are also recommended since many subtle joint impaction or fracture lines are not visible on the two views.
• CT with reformations is a study of choice to delineate the extent, orientation of condyle, location and depth of articular comminution and impaction
• Schatzker classification divides tibial plateau fractures into 6 types: lateral plateau without depression, lateral plateau with depression, lateral or central plateau compression, medial plateau, bicondylar plateau, plateau fracture with diaphyseal discontinuity.
• Based on the classification, the management is different. The first three: repair the articular cartilage. The latter three: treatment depends on location of soft tissue injury.

Reference:

Markhardt BK, Gross JM, Monu J. Schatzer classification of tibial plateau fractures: use of CT and MR imaging improves assessment. RadioGraphics 2009