Tibial Plateau Fractures

Also Known as:

Bumper fractures.

These fractures occur in adults of all ages but are more prevalent in those aged over 50 years.

Mechanism of Injury

These fractures occur as a result of the knee joint being forced into varus or valgus. They commonly occur as a result of road traffic accidents ('bumper fractures') or falls from a height. Depending on the direction of the injuring force, the ipsilateral ligaments become taut while the opposite femoral condyle bears down the tibial plateau.

Classification

Schatzer’s classification is most commonly used:

• Type 1 - a simple fracture of the lateral tibial plateau with no depression of the articular surface. Commonly occurs in younger patients
• Type 2 - a comminuted crush fracture of the lateral plateau with depression of the articular surface. Commonly seen in older patients
• Type 3 - a fracture of the lateral plateau with depression, but no splitting of the articular surface
• Type 4 - fracture of the medial tibial plateau
• Type 5 - split fractures of both tibial plateaus
• Type 6 - Combined fracture of the tibial plateau and a subcondylar fracture

Clinical Features

The knee is painful, often deformed and swollen as a result of haemarthrosis. Tenderness is present over the fracture site and movement is limited. Examination will reveal either medial or lateral instability.

X-rays in three views are needed to confirm the diagnosis: AP, lateral and oblique.