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J Am Acad Orthop Surg, Vol 14, No 1, January 2006, 20-31.
© 2006 the American Academy of Orthopaedic Surgeons
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High-Energy Tibial Plateau Fractures

Eric M. Berkson, MD and Walter W. Virkus, MD

Dr. Berkson is Resident, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL. Dr. Virkus is Assistant Professor, Department of Orthopedic Surgery, Rush University Medical Center, and Senior Attending Surgeon, Cook County Hospital, Chicago.

Neither Dr. Berkson nor the department with which he is affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article. Dr. Virkus or the department with which he is affiliated has stock or stock options held in Stryker Corporation. Dr. Virkus or the department with which he is affiliated serves as a consultant to or is an employee of Stryker Corporation.

Reprint requests: Dr. Virkus, Rush University Medical Center, 1725 W Harrison Street, Suite 440, Chicago, IL 60612.

The severity of a tibial plateau fracture and the complexity of its treatment depend on the energy imparted to the limb. Low-energy injuries typically cause unilateral depression-type fractures, whereas high-energy injuries can lead to comminuted fractures with significant osseous, soft-tissue, and neurovascular injury. Evaluation includes appropriate radiographs and careful clinical assessment of the soft-tissue envelope. Treatment is directed at safeguarding tissue vascularity and emphasizes restoration of joint congruity and the mechanical axis of the limb. Temporary joint-spanning external fixation facilitates soft-tissue recovery, whereas minimally invasive techniques and anatomically contoured plates can limit damage to the soft tissues and provide stable fixation. Alternatively, the use of limited internal fixation and definitive external fixation can minimize soft-tissue disruption, avoid complications, and allow fracture union. Complications, including infection, loss of fixation, and malalignment, are best avoided by following these biologically respectful treatment principles.




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V. Musahl, I. Tarkin, P. Kobbe, C. Tzioupis, P. A. Siska, and H.-C. Pape
New trends and techniques in open reduction and internal fixation of fractures of the tibial plateau
J Bone Joint Surg Br, April 1, 2009; 91-B(4): 426 - 433.
[Abstract] [Full Text] [PDF]


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Copyright © 2006 by the American Academy of Orthopaedic Surgeons.