What is the treatment for a tibial plateau fracture?
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.
Bone bruise or a nondisplaced fracture:
In cases where there is a bone bruise or a nondisplaced fracture that 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, including low resistance cycling and working in a pool, can help to maintain one’s cardiovascular endurance and allow for a quicker return to activities.
Bone bruise with a small fracture:
In circumstances where there is bone bruise with a small fracture that 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.
Tibial plateau fractures requiring surgery:
We have found it very beneficial to concurrently fix tibial plateau fractures with an arthroscope viewing inside the knee to assess the reduction of the joint surfaces during the surgical fixation. This ensures that the fracture pieces are put back together as closely as possible which may not be possible if one is relying solely on x-rays to determine if the fracture is reduced.
How long does it take to recover from a tibial plateau fracture or injury?
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 fractures with a larger disruption of the bone, the athlete may need to be non-weightbearing for 6 weeks and then will need time to recover from the atrophy of not walking on that extremity prior to returning to activities. A slow progression off crutches may then be performed once the athete can walk without a limp and x-rays show sufficient healing. Every plateau fracture is different, so judging the timing of a return to activities is injury specific.
For athletes who require surgery to stabilize the fracture or restore the step-off deformity; the downtime is usually much extended with at least 6 weeks of non-weightbearing and up to several months of rehabilitation to restore overall strength. In cases with significant traumatic arthritis due to cartilage damage, continued problems with pain or swelling may affect the athlete’s ability to return to high-level activities and can affect the length of their athletic career. In circumstances of extreme atrophy, arthritis or multiple fracture, it can take 12 weeks or longer to return to activities.