Fractures of tibial plateaus. A review of the literature.

Tibial plateau fractures, common injuries in the middle-aged, often result from falls or vehicular accidents. The wide spectrum of fracture patterns can be theoretically related to the sequential application of bending (valgus/varus) and compression forces. End-results of 599 fractures in 13 different studies were compared by fracture pattern using a clear-cut fracture classification. Minimally displaced (less than 5-10 mm displacement) fractures average 85-90 per cent acceptable end-results. Associated soft tissue lesions include frequent meniscal (50% of cases) and ligamentous (10-30%) injuries. Vascular and nerve injuries are most unusual: non-union is not reported. A diagnostic and therapeutic approach is outlined. The assessment of bony and/or ligamentous instability is stressed. Reduction is required in most displaced fractures: open reduction and rigid internal fixation with ample bone grafting is suggested in displaced local depression fractures and other unstable fracture types refractory to closed reduction. Operative repair of ruptured ligaments seems indicated. Early knee motion is important in all fractures. In unstable fractures angular alignment must be maintained (rigid internal fixation, skeletal traction, or bracing) during early motion. Quadriceps rehabilitation must be vigorous. Weight-bearing should be deferred for at least three months. The cast brace is useful in unicondylar fractures.