Tibial Plateau Fractures

For Medical Students

What It Shows

A tibial plateau fracture is a break involving the articular surface of the proximal tibia. 2.2.2 covers the tibial plateau.

Computed tomography shows which parts of the plateau are involved, how far the surface is depressed, and where each fragment sits. 5.2.22 covers the CT acquisition.

It matters because the approach and the fixation follow the fragment pattern, which a radiograph understates. 5.3.11 covers tibial plateau fractures.

How It Is Acquired

Start from the radiographs, which establish the injury and the alignment. 5.3.11 covers tibial plateau fractures.

Acquire thin slices through the whole plateau with coronal and sagittal reformats. 5.2.23 covers the reconstruction.

Assess the medial and the lateral surface separately, and the posterior part of each. 2.2.1 covers the proximal tibia.

Assess the articular depression against the adjacent intact surface. 2.2.2 covers the tibial plateau.

Assess the metaphyseal extension and the fibular head. 2.2.4 covers Gerdy's tubercle.

What Normal Looks Like

A continuous articular surface across both plateaus. 2.2.2 covers the tibial plateau.

An intact posterior cortex on the sagittal reformats. 2.2.1 covers the proximal tibia.

No metaphyseal fracture line running down from the surface. 5.3.11 covers tibial plateau fractures.

An intact tibial spine with its attachments. 2.2.3 covers the tibial spine.

What Abnormal Looks Like

Depression of one articular surface relative to the other. 2.2.2 covers the tibial plateau.

A split fragment with its own displacement and its own cortical margins. 5.3.11 covers tibial plateau fractures.

A posterior fragment, medial or lateral, which the anteroposterior radiograph does not show. 5.3.1 covers the AP view.

Metaphyseal comminution separating the surface from the shaft. 2.2.1 covers the proximal tibia.

A Segond fragment or a fibular head injury pointing at the lateral structures. 5.3.15 covers Segond fractures.

MRCS Level

How It Is Acquired

In a viva the expected answer describes the fragments before naming a classification.

The expected points are the radiographs, the thin slices and reformats, each surface separately, the posterior fragments, and the metaphyseal extension.

Say that the classification follows the description rather than replacing it. 5.20.1 covers structured reporting.

Say that the soft tissue injuries need a separate study. 5.5.1 covers the standard protocol.

Say that the fibular head and the lateral structures are part of the injury. 5.3.15 covers Segond fractures.

What Abnormal Looks Like

The reasoning expected is that the plateau is several regions loaded differently rather than one surface, so a fracture's region predicts both the approach and the load the repair will carry. 3.5.1 covers the contact areas.

A posterior fragment cannot be reduced or held through an anterior approach, which is why its detection changed practice. 2.2.1 covers the proximal tibia.

Articular depression left unreduced alters contact pressure over a small area. 3.5.2 covers the contact pressures.

Metaphyseal comminution decides whether the fixation has to bridge rather than compress. 5.3.11 covers tibial plateau fractures.

How Good It Is

Computed tomography is the best available test of this fracture's architecture and routinely leaves the knee's other injuries undocumented.

Its best contribution is the fragment map and the posterior involvement. 2.2.1 covers the proximal tibia.

It is limited because these injuries carry meniscal, cruciate and collateral damage that the scan cannot show and that affects the outcome. 5.5.9 covers the ligaments.

No figures appear for accuracy on this page, under decision 028, and no depression thresholds or fragment size values appear either: those are published quantities tied to particular classifications and this environment cannot check them.

FRCS Level

How Good It Is

At decision level the scan sets the approach, the patient position and the implant, so its description has to be a surgical one. 5.20.1 covers structured reporting.

The posterior fragments decide whether a posterior approach is needed at all. 2.2.1 covers the proximal tibia.

The articular surface decides whether the reduction can be achieved indirectly. 2.2.2 covers the tibial plateau.

A magnetic resonance study changes the plan often enough in these injuries to be worth the delay. 5.5.1 covers the standard protocol.

Alignment on the long leg film is what the fixation has to restore, and the scan does not carry it. 5.3.6 covers the long leg alignment films.

Where It Misleads

The commonest error is treating a complete fracture description as a complete injury description. 5.5.9 covers the ligaments.

A meniscus displaced into the fracture is invisible on the scan and blocks the reduction. 5.6.11 covers meniscal extrusion.

A root avulsion accompanies these injuries and is not a scan finding. 5.6.9 covers root tears.

Traction or a splint at the time of scanning reduces fragments the surgeon will meet unsupported. 5.1.6 covers imaging pitfalls.

Thick reformats smooth a depressed surface into a continuous one. 5.2.23 covers the reconstruction.

Fellowship Level

Where It Misleads

At fellowship level these knees arrive after fixation, with stiffness, pain or deformity, and the question is what the surface looks like now. 5.12.8 covers the post-operative imaging.

Metal artefact sits over the articular surface, which is the part the revision question concerns. 5.2.19 covers the artefacts.

The original scan is the only record of the pre-operative anatomy and often does not travel with the patient. 5.20.7 covers reporting the post-operative knee.

Post-traumatic arthritis follows the residual incongruity and the alignment rather than the classification, so the follow-up imaging is radiographic. 5.3.6 covers the long leg alignment films.

Classification agreement between surgeons is a known weakness and is not improved by a better scan. 5.1.7 covers evidence-based imaging.

The useful report gives the fragments with positions, the surfaces with their references, the posterior involvement, the metaphyseal extension, and the soft tissue question stated as open. 5.20.1 covers structured reporting.