Description of Tibial Plateau Fractures
Fractures which involve the tibial plateaus range from very small fractures, which are only seen on MRI scans, to those which involve a significant injury, which results in a Humpty-Dumpty appearance of several bone pieces which can be almost impossible to put back together. While those with fractures which only show up on MRI scan have an excellent outcome and a fairly quick return to activities, those involving significant disruption with multiple pieces of the lateral tibial plateau often have a poor prognosis.
Symptoms of a Tibial Plateau Fracture
- Pain when weight is applied
- Limited range of motion
- Severe cases – numbness or “pins and needles” in the foot due to nerve damage
The tibial plateau is made of cancellous bone, which is softer than the thicker bone lower in the tibia. Tibial plateau fractures are caused by a force driving the lower end of the femur (thigh bone) into the soft bone of the tibial plateau. The impact often causes the cancellous bone to compress and remain sunken. This damage to the tibial plateau may result in improper limb alignment, and over time can lead to arthritis, instability, and loss of motion in the knee.
It is not uncommon in athletic activity, such as with skiers, basketball players, football players, and court type sports to sustain a “bruise” of the bone. In these circumstances, the bone sustains enough of a load such that there is some swelling of the bone, but that an actual fracture does not occur. In some of these instances, such as with an ACL tear, there can be a disruption of the bone with a small fracture which only shows up on an MRI scan. These types of fractures have a very good prognosis and a period of time to allow the bone bruise and fracture to heal is required.
Treatment for Tibial Plateau Fractures
In cases where there is solely a bone bruise or a very mild nondisplaced fracture, the treatment can vary dramatically compared to those where there is a complete fracture or any step-off deformity or comminution of the fracture. In those cases where there is a bone bruise or a nondisplaced fracture which does not cause significant pain, such as in high-level athletes, a rehabilitation program to allow the swelling to resolve followed quickly by, a low-impact exercise program, to include low resistance cycling and working in a pool, can help to maintain ones cardiovascular endurance and allow for a quicker return to activities.
In circumstances where there is bone bruise with a small fracture which is not displaced surgery is not required, if the athlete is able to participate in low-impact activities without having any problems with pain or swelling, they can often maintain their cardiovascular reserves to the point where they do not need an extended period of time after the fracture heals to return to sporting activities.
In certain cases, a minimum of 6 weeks is usually necessary to allow the fracture to completely heal so that there is no risk of a reinjury. In those fractures in which there is a larger disruption of the bone, the athlete may need to be nonweightbearing for 6 weeks and then will need time to recover from the atrophy of not walking on that extremity prior to returning to activities. In those circumstances, it can 12 weeks or longer to return to activities. In those athletes we do require surgery to stabilize the fracture or restore the step-off deformity; the downtime is usually much extended with at least 6 weeks of no weightbearing and up to several months of rehabilitation to restore their overall strength. In addition, if there is any significant traumatic arthritis because of damage to the cartilage, some patients may continue to have problems with pain or swelling with activities that can affect the ability to return back to high-level activities and can affect the length of their athletic career.