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1. Tibial Plateau Fracture Assoc. Prof. Dr. MD. Tajul Islam Unit chief Blue unit 2 National Institute of Traumatology & Orthopaedic Rehabilitation

2. Introduction Tibial plateau fracture involves the proximal tibia articular surface. Represents 1% of all fractures and 8% of elderly fractures. Commonly caused by high-energy trauma or falls in osteoporotic patients.

3. Applied Anatomy Tibial plateau forms the lower articular surface of the knee joint. Consists of medial and lateral condyles. Medial plateau: concave and stronger; Lateral: convex and weaker.

4. Mechanism of Injury Axial loading with varus or valgus forces. High-energy injuries: road traffic accidents. Low-energy: falls in osteoporotic bone.

5. Classification Schatzker (most commonly used) Type-1 : Vertical split of lateral condyle Type-2 : A vertical split of lateral condyle combined with depression of an adjacent load bearing condyle Type-3 : Depression of the articular surface with an intact condylar rim

6. Type-4 : Fracture of the medial tibial condyle Type-5 : Fracture of both condyle Type-6 : Combined condylar & sub-condylar fracture

7. AO Classification Based on articular involvement and comminution . Type A: Extra-articular. Type B: Partial articular. Type C: Complete articular fractures.

8. Column Theory with landmarks

9. Clinical Features Pain S welling D eformity around the knee. Inability to bear weight.

10. Physical Examination Inspect for swelling and abrasions. Palpate for tenderness and crepitus. Assess neurovascular status. Check for open wounds and compartment syndrome .

11. Compartment syndrome It is a syndrome complex developed due to deprivation of circulation in a group of muscle within a closed osteofascial compartment due to raised intra- compertmental pressure. It is clinical diagnosis. The earliest of the ‘classic’ features is severe pain ( or a ‘bursting’ sensation) & this may be the only feature seen.

12. Affected limb should be examined at 30 minutes intervals and if there is no improvement within two hours of splitting dressings, fasciotomy should be performed. Intracompartmental pressure >30mmHg or differential pressure (difference between diastolic pressure & compartment pressure) less than 30mmHg is confirmatory. Usually done in unconscious patient.

13. Double incision fasciotomy is best & most safely accomplished through two incisions, one anterolateral & other is posteromedial. Anterolateral incision is made about 2-3cm lateral to the tibial crest & extend from the level of tibial tuberosity to just above the ankle. A second, similar incision is made just posterior to the posteromedial border of the tibia.

14. Double Incision fasciotomy

15. Imaging X-ray: AP, lateral, and oblique views. CT scan: defines fracture geometry. MRI: evaluates meniscal or ligamentous injuries.

16. Radiological Evaluation Measure depression and displacement. Identify involvement of condyles. Detect joint incongruity and associated fractures.

17. Treatment Depends on displacement, depression, and stability. Goal: Restore joint congruity and stability. Methods: Non-operative or operative.

18. Non-operative Management Indications: minimally displaced or stable fractures. Technique: Long leg cast or hinged brace. Early mobilization and physiotherapy.

19. Surgical Options ORIF (Open Reduction and Internal Fixation). MIPO plating. Percutaneous screw fixation. External fixation in polytrauma or open injuries.

20. Surgical Approach es Anterolateral: for lateral plateau. Medial: for medial plateau. Dual incision: for bicondylar fractures.

21. Anterolateral approach

22. Posteromedial approach

23. Posterior Approach

24. Fixation Techniques • Buttress plating (locking plate). • Cancellous screws for depression fractures. • Bone grafting for articular elevation defects.

25. Complications Compartment syndrome. Infection, stiffness, malunion , or nonunion. Post-traumatic osteoarthritis. I mplant failure.

26. Pediatric Considerations Rare in children due to elastic bone. Managed conservatively in most cases.

27. Rehabilitation Week 0–2: Passive ROM. Week 3–6: Active-assisted ROM. Week 6–12: Gradual weight bearing. No weight bearing in case of intra-articular fracture fixation for a minimum 10-12 weeks. The goal is to achieve as full range of motion as possible within 1 st 4-6 weeks.

28. Follow-up Wound healing should be assessed on a short term basis for within 1 st 2weeks. Then subsequently at 6 th & 12 th week.

29. Thank You All