![]() In some of these patients, TKA can be considered as primary mode of treatment. In older, lower demand patients, ORIF is potentially less favorable for a variety of reasons, namely fixation failure and the need for delayed weight bearing. However, future total knee arthroplasty (TKA) is a consideration in these patients as post-traumatic osteoarthritis is a common long-term complication of tibial plateau fractures. In physiologically young patients with higher demand and better bone quality, ORIF is the preferred method of treating these fractures. While there are various treatment options for displaced tibial plateau fractures, the standard of care is open reduction and internal fixation (ORIF). Often these types of fractures are accompanied by extensive soft tissue injuries and risk of compartment syndrome ( a painful condition where pressure within the muscles builds to dangerous levels).Tibial plateau fractures are common injuries that occur in a bimodal age distribution. This is a high energy injury involving complex varus and valgus forces. Type VI - Plateau and metaphyseal-diaphyseal dissociation: The main feature of this type of fracture is a transverse subcondylar fracture with dissociation of the metaphysis from the diaphysis.Generally a small amount of metaphyis remains attached to the joint. ![]() May also include damage or injury to the anterior cruciate ligament and collateral ligaments. It is usually the result of a high energy injury with a pure axial load. Type V - Bicondylar: These fractures consist of a split fracture of the medial and lateral tibial plateau.May represent a reduced knee fracture-dislocation and subsequent ligament injuries are common. Most commonly associated with neurovascular injury. It is usually the result of a high energy injury and involves a varus force (pushing the knee outwards) with axial loading at the knee. Type IV – Medial plateau: This is a medial tibial plateau fracture with a split or depressed component.This classification of fracture is extremely rare and can result in joint instability. This is a low energy injury typically a result of osteoporotic changes in bone. Central depressions are more stable than lateral or posterior. Type III - Depression lateral plateau: This is a pure compression fracture of the lateral or central tibial plateau in which the articular surface of the tibial plateau is depressed.This is the most common classification of tibial plateau fracture. This is a low energy injury typically a result of osteoporotic changes in bone and occurs most commonly in older patients. Caused by a valgus force (pushing the knee inwards) on an axially loaded limb. Type II - Split depression lateral plateau: This is a combined cleavage and compression fracture and involves vertical split of the lateral condyle combined with depression of the adjacent load bearing part of the condyle. It is common to have a lateral tear to the meniscus. May be caused by a valgus (force pushing the knee inwards) combined with axial loading. It is usually the result of a low energy injury in young individuals with normal bone mineralisation. ![]()
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