A tibial plateau fracture is a complete or incomplete break in the larger of the two leg bones (tibia) involving the knee joint. These fractures have been called “bumper injuries” because the tibial plateau can be fractured when struck by a car bumper.
What Is a Tibial Plateau Fracture?
A tibial plateau fracture is a complete or incomplete break of the tibia involving the knee joint. The tibial plateau is susceptible to fracture because there is relatively little soft tissue around the area and the bone of the tibia at the knee joint is relatively soft.
Causes and Risk Factors
Tibial plateau fractures can result from:
- An injury that causes a force greater than the bone can withstand
- A direct blow
- Indirect stress caused by twisting or bending
Risk factors include:
- Contact sports
- Motor sports
- Bony abnormalities, including osteoporosis, and tumors of bone
- Metabolic disorders, hormone problems, and nutritional deficiencies and disorders
- Poor physical conditioning, including strength and flexibility
- Obesity
Symptoms
Common signs and symptoms of a tibial plateau fracture include:
- Severe pain in the leg at the time of injury
- Tenderness and swelling in the leg or calf
- Bleeding and bruising in the leg
- Inability to bear weight on the injured leg
- Visible deformity if the fracture is complete and the bone fragments separate enough to distort the normal contours of the leg
- Numbness and coldness in the leg and foot beyond the fracture site if the blood supply is impaired
Treatment
Initial treatment consists of medications, elevation of the leg, and ice to relieve pain and reduce swelling.
If the fracture is in proper alignment and position, treatment requires immobilization with a brace. Surgery is recommended to reduce the fracture into proper alignment and use plates or screws to hold the fracture in alignment and restore the joint surface.
Occasionally, a bone graft from the hip or a bone bank may be used to support the reduction of the joint surface because the fracture can leave a void when the bone is pushed back into place. Surgery may be performed through an open incision. For certain fractures, arthroscopy may be used to assist in confirming restoration of a smooth joint surface.
After immobilization, with or without surgery, stretching and strengthening of the injured and weakened joint and surrounding muscles are necessary. This may be done with or without the assistance of a physical therapist or athletic trainer.
Recovery and Outcomes
Recovery can require six weeks of non-weight bearing and a total of six months to recover.
With appropriate treatment, this condition is usually curable.
Potential complications include:
- Failure to heal (nonunion)
- Healing in a poor position (malunion)
- Compartment syndrome, in which excessive pressure from swelling within the leg can block small blood vessels and injure muscles and nerves
- Shortening of the injured bones
- Arrest of normal bone growth in children
- Risks of surgery, including infection, bleeding, injury to nerves resulting in numbness, weakness, or paralysis, and the need for further surgery
- Infection in open fractures when the skin is broken over the fracture site
- An unstable or arthritic knee joint
- Prolonged healing time if activity is resumed too quickly
- Proneness to repeated leg injury
- Stiff knee
When to See Dr. Chudik
Schedule an evaluation after any significant knee injury with inability to bear weight, severe swelling, or concern for fracture. Call 630-324-0402 or request an appointment online.