Schatzker classification system is one method of classifying tibial plateau fractures increase in type number denotes increasing severity, reflecting an increase in energy imparted to the bone at the time of injury and also an increasingly worse prognosis 1. Tibial plateau fractures are complex injuries of the knee. Populationbased epidemiology of tibial plateau fractures. Physiotherapy tibial plateau fracture tibial plateau. It involves the cartilage surface of the knee joint. Patients will be in a hinged brace for support and to serve as a reminder not to weightbear. This approach is typically utilized for splitdepression lateral plateau schatzker type ii and bicondylar schatzker type vi, type v fracture patterns. A comprehensive classification of tibial plateau fractures should group fractures that are similar in topography, morphology, and pathogenesis, requiring similar treatment, and having a similar prognosis. Closed kinetic chain multiplane hip strengthening on uninvolved side. A tibial plateau fracture generally results from trauma to the upper part of your shin. Classification useful for 1 true fracturedislocations 2 fracture patterns that do not fit into the schatzker classification 10% of all tibial plateau fractures 3 fractures associated with knee instability.
Whereas open surgical procedures are associated with increased softtissue trauma because of the extent of the surgical approach and do not always allow for. The extent of your recovery will often depend on the amount of effort. Recovery from a tibial plateau fracture is different from person to person. Tibial plateau fractures can be divided into two different categories nondisplaced and displaced tibial plateau fracture. The wellbeing of your recovery from fractured tibial plateau or tibial plateau fractures is determined by making healthy decisions and commitment to. This is an uncommon injury and often has a poor prognosis and very long recovery. His rehabilitation was quite successful, resulting in a good range of.
Learn signs of the fracture and surgical and nonsurgical treatment plans. About 50% of tibial plateau fractures are associated with meniscal injuries, while ligament injuries can be found in up to 25% of cases4, 5, 6. Controversy and confusion exists with the term shin splints. The longterm outcome of tibial plateau fractures treated by cast bracing was observed in 29 patients sustaining 30 tibial plateau fractures more than ten years after injury. The most common mechanism of injury is motor vehicle accident. The schatzker 6 and otaao 7 classification systems are the most commonly used systems for the assessment of. Fractures of the proximal tibia shinbone orthoinfo aaos.
Christopher metzger, mark lombardi, in a comprehensive guide to geriatric rehabilitation third edition, 2014. Schatzker classification of tibial plateau fractures. A tibial plateau fracture refers to a break or crack in the top of the shin bone, at the knee. Identify common fracture patterns apply treatment principles and strategies partial articular fractures complete articular fractures discuss rehabilitation, complications, and outcomes illustrate selected tibial plateau cases. This case study will present one of the most common problems associated with a tibial plateau fracture and describe some.
It is prone to becoming fractured in high speed accidents such as those associated with skiing, horse riding and certain water sports. Tibial plateau fracture brigham and womens hospital. Tibia fibula fracture rehabilitation protocol pdf in this article, we are going to learn just an overview of the protocol. During the first week or so exercise will concentrate mainly around recovering from the effects of the surgery. You have this type of fracture when the tibia has sustained a. Regular manual treatment should be conducted to the patella and all incisionswith particular attention to the anterior medial portalto decrease the.
It depends very much on the exact type and specifics of injury, your age, prior issues, level of physical activity, physiotherapy, nutrition and many other factors. Discuss rehabilitation, complications, and outcomes. Here we describe a case of knee injury following a road tra. Given all of these differences it is still quite safe to say that for most people, if you the injury was. In this type of fracture, the tibial plateau or the tibia is fractured without any bone fragment separation. Cureus tibial plateau fracture with avulsion fracture of. The subject of classification of tibial plateau fractures can be confusing. Tibial plateau fracture phase i maximum protection 0 to 1 weeks.
An important complication of tibial plateau fracture is compartment syndrome, occurring in up to 10% of cases. You will be guided by you physical therapist pt through the rehabilitation process for fractured tibial plateau or tibial plateau fracture. Ice and modalities to reduce pain and inflammation use crutches nonweight bearing for 6 weeks brace for 6 weeks in full extension elevate the knee above the heart for the first 3 to 5 days. Tibial plateau fracture figures 1494 through 1498 is a clinically important and sometimes relatively occult injury on plain radiographs. The tibial plateau is one of the most critical loadbearing areas in the human body. The top surface of the tibia the tibial plateau is made of cancellous bone, which has a honeycombed appearance and is softer than the thicker bone lower in the tibia. Mikkelsen 1 has classified 18 types of fracture involving the proximal articular surface of the tibia. Symptoms include pain, swelling, and a decreased ability to move the knee. Use manual muscle testing mmt of joints proximal and distal to the knee, as. A tibial plateau fracture is a break of the upper part of the tibia shinbone that involves the knee joint. A tibial plateau fracture is a bone fracture or break in the continuity of the bone occurring in the proximal part of the tibiaor shinbone called the tibial plateau.
Tibial plateau fracture causes, types, symptoms, diagnosis. Will 3dimensional classification of tibial plateau. Complication may include injury to the artery or nerve, arthritis, and compartment syndrome. Pdf treatment strategy for tibial plateau fractures. In the first stage of rehabilitation from a tibial plateau fracture, your knee must be immobilized for.
However, three types of fractures generally occur in. Allarthroscopic treatment of schatzker type iii lateral. The conservative treatment of fractures of the lateral tibial plateau has in our experience produced an excellent functional result. The prognosis of tibial plateau fractures directly depends on four factors. Tibial plateau fracture open reduction internal fixation stage 1 day 1 4 weeks. Tibial plateau fractures tpfs are regarded as challenging fractures to reduce and stabilise, typically requiring complex open reduction and internal. Tibial plateau fractures university hospitals coventry.
Joshua broder md, facep, in diagnostic imaging for the emergency physician, 2010. Currently, there are 38 different classifications based on different theories of 2, 3, 4, and 10column tibial fracture patterns that are most commonly recognized and analyzed in the literature 15. Loss of fracture reduction, knee sti ness and prolonged rehabilitation are common problems. Tibial plateau fracture treatment remains challenging for orthopaedic surgeons around the world, especially in case of type iii fractures according to the schatzker classification, which are a pure depression of the lateral tibial plateau. Characteristics of postoperative weight bearing and. Rehabilitation from tibial plateau knee surgery healthfully. A new approach to surgical management of tibial plateau. The cause is typically trauma such as a fall or motor vehicle collision.
The tibial plateau is located on the upper surface of your tibia just below your kneecap. Physiotherapy and recovery for fractured tibial plateau or. Tibial plateau fractures were originally termed a bumper or fender fracture but only 25% of tibial plateau fractures result from impact with automobile bumpers. In the first stage of rehabilitation from a tibial plateau fracture, your knee must be immobilized for six to eight weeks to allow your tibial plateau to heal. Tibial plateau fractures are serious injuries, and are common in highimpact sports like football, rugby and basketball. He was treated with open surgical reduction and internal.
After a fracture, physical therapy may be required to help ensure return to. Implement reintegration exercises emphasizing core stability. Sometimes associated soft tissue damage may be quite significant. Department of orthopaedics tibial plateau fracture the tibial plateau is the upper surface of the tibia or shin bone. Tibial plateau fracture postoperative protocol rosenberg cooley. Associate professor of orthopaedics chief, division of sports medicine tel. Always seek immediate medical attention after incurring a tibial plateau injury. Early detection and appropriate treatment of these fractures are essential in minimizing patients disability in range of movement, stability and reducing the risk of documented complications. Twisting motions and motor vehicle accidents can also cause a tibial. Department of rehabilitation services physical therapy standard of care. Tibial plateau fractures initial management guidelines.
Functional outcome and incidence of osteoarthritis in 125 cases article pdf available in international orthopaedics 344. Rehabilitation guidelines for tibial plateau fracture open reduction internal fixation stage 1day 14 weeks. Non displaced fractured tibial plateau or non displaced tibial plateau fractures have a better prognosis than displaced fractures and often heal within 34 months without any surgical intervention, but the patient should not bear weight. Pdf tibial plateau fractures are complex injuries produced by high or low energy. This means, for example icing and leg elevation to reduce inflammation and pain, regaining initial knee range of motion and motor control the ability to bend your knee, and getting used to getting around on crutches. The current study reported uptodate information on the incidence and basic epidemiology of tibial plateau fractures in a large and unselected population, including the. Tibial tuberosity fractures are usually seen in the adolescent age group and are very rare in adults. Tibial plateau fractures can occur as a result of highenergy trauma or in lowenergy trauma. Rehabilitation for tibial plateau fractures in adults. Tibial plateau fracture postoperative protocol phase i maximum protection 0 to 1 weeks. Fracture dislocations and standard tibial plateau fractures should be incorporated into a single classification to avoid the use of two complementary. The patient had tibial tuberosity avulsion along with tibial plateau fracture.
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