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Tibial Plateau Fractures What is a tibial plateau fracture? By Jonathan Cluett, M.D., About.

com Guide Updated September 26, 2005

Tibial Plateau Fracture (Continued from Page 1) A tibial plateau fracture occurs at the top of the shin bone, and involves the cartilage surface of the knee joint. Because these fractures occur around the knee joint, they must be treated differently than the tibial shaft fractures discussed previously. When a fracture occurs into or around a joint surface, that joint is at high risk of developing arthritis due to the injury. Unfortunately, even if the bone and cartilage surfaces are lined up perfectly, there is still a risk of developing arthritis due to injury to the cartilage cells. Treatment of Tibial Plateau Fractures

Non-Displaced Tibial Plateau Fractures Non-displaced fractures are cracks in the bone seen on x-ray, but with the bones remaining in their proper position and alignment. Most non-displaced fractures of the tibial plateau can be treated without surgery, but they usually require an extended period (about 3 months) of protection from walking. Some non-displaced fractures are at risk for displacing (shifting position) in the days and weeks following injury, and therefore these injuries must be closely watched by your orthopedic surgeon. If displacement occurs, surgery may be needed to realign the bone fragments and hold them in position.

Displaced Tibial Plateau Fractures Displaced fractures often require surgery to realign the bones and restore stability and alignment of the knee joint. There are several surgical options in the treatment of tibial plateau fractures; choosing the type of procedure depends on the fracture pattern--certain types of fractures may or may not be amenable to treatment with a particular type of surgery. Surgical treatments usually involve the placement of screws and plates into the fractured bone. If the bones are lined up well, this procedure may be treated with small incisions using x-ray to line up the bones. If there is more displacement of the fragments of bone, a larger incision will be needed to piece together the fragments. To hold the bone fragments in place, either screws alone, or plates and screws can be used. Screws alone are usually used when one piece of bone has broken off, and can be easily repositioned. If the tibial plateau fracture

requires additional support, a plate will be placed along the bone to help support the fragments while healing takes place. What is the recovery from a tibial plateau fracture? Recovery from a tibial plateau fracture can take several months. Because the cartilage surface of the joint is involved, the knee must be protected from weight until the fracture has healed. Most commonly patients will be allowed to move the knee joint, but not put weight on the leg for about three months. The exact length of time of limitations will vary on the fracture type and the amount of healing that takes place

Tibia Fracture By Jonathan Cluett, M.D., Guide Updated September 26, 2005 Health's Disease and Condition content is reviewed by the Medical Review Board See More About:

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Ads Hydroxyapatite Nanopowder20 nm, 40 nm, 60 nm, Ultra Pure Hydroxyapatite SPINE SERVICEGot neck or back issues Get a team based The tibia is the major bone of the lower leg, commonly referred to as the shin bone. Tibia fractures can occur from many types of injuries. Tibia fractures come in different shapes and sizes, and each fracture must be treated with individual factors taken into account. When determining treatment of a tibia fracture, the following factors must be considered:

Location of the fracture, Displacement of the fracture, Alignment of the fracture, Associated injuries, Soft-tissue condition around the fracture, and Patient general health. In general, tibia fractures can be separated into three categories based on the location of the fracture. Specific issues concerning these fractures are discussed on the following pages. It should be noted that open, or compound, fractures must be treated specially. Open fractures occur when the fractured bone is open through the skin. These fractures are at especially high-risk of developing an infection, and generally require surgical treatment in all cases.

Tibial Shaft Fractures Tibial shaft fractures are the most common type of tibia fracture and occur between the knee and ankle joints. Most tibial shaft fractures can be treated in a long leg cast. However, some fractures have too much displacement or angulation and may require surgery to realign and secure the bones. Tibial Plateau Fractures Tibial plateau fractures occur just below the knee joint. These fractures require consideration of the knee joint and its cartilage surface. Tibial plateau fractures can lead to a chance of developing knee arthritis. Tibial Plafond Fractures Tibial plafond fractures occur at the bottom of the shin bone around the ankle joint. These fractures also require special consideration because of the ankle cartilage surface. Tibial plafond fractures are also concerning because of potential damage to surrounding soft-tissues. Tibial Shaft Fractures Tibial shaft fractures are common injuries that can occur after falls, car accidents, sports injuries, and other activities. A tibial shaft fracture can be treated by several methods depending on the type of fracture and alignment of the bone. The most common treatments include:

Casting A cast is appropriate for tibial shaft fractures that are not badly displaced and are well aligned. Patients need to be in a cast that goes above the knee and below the ankle (a long leg cast). The advantage of casting is that these fractures tend to heal well and casting avoids the potential risks of surgery such as infection. Patients with casts must be monitored to ensure adequate healing of the tibia and to ensure the bones maintain their alignment. Intrameduallary (IM) Rodding Intrameduallary rodding is a procedure to place a medal rod down the center of the tibia to hold the alignment of the bone. A tibial rodding is a surgical procedure that lasts about an hour and half and is usually done under general anesthesia. Patients will have an incision over the knee joint, and small incisions below the knee and above the ankle. In addition, some fractures may require an incision near the fracture to realign the bones. IM rods are secured within the bone by screws both above and below the fracture. The metal screws and the rod can be removed if they cause problems, but can also be left in place for life. Tibial rodding provides excellent

fixation and alignment of the bones. The most common risk of surgery is knee pain, and the most concerning complication is infection. Infection of the rod may require removal of the rod in order to cure the infection.

Plates and Screws Plates and screws are less commonly used, but are helpful in some fracture types, especially those closer to the knee or ankle joints (see information on tibial plateau and tibial plafond fractures). Most surgeons choose an IM rod for tibial shaft fractures unless the fracture is too close to the joint to allow for placement of the IM rod. In these fractures close to the joint surface, a plate and screws may be the ideal method of fixation. External Fixator An external fixator may also be helpful in some particular fracture types. External fixators tend to be used in more severe fractures, especially open fractures with associated lacerations and soft-tissue damage. In these cases, the placement of IM rods or plates may not be possible because of soft-tissue injury. When there is significant soft-tissue injury, the external fixator may provide excellent immobilization while allowing monitoring and treatment of the surrounding soft-tissues. Tibial Plafond Fractures What is a tibial plafond fracture?

By Jonathan Cluett, M.D., Guide X-ray image of a tibial plafond fracture. Note the fracture line extends into the ankle joint. A tibial plafond fracture (also called a tibial pilon fracture) occurs at the end of the shin bone and involves the ankle joint. As was the case with tibial plateau fractures, these injuries occur close to the joint surface and must be treated with the cartilage surface of the joint in mind. Tibial plafond fractures occur just above the ankle joint and often involve the cartilage surface of the ankle joint. The other major factor that must be considered with these injuries is the soft-tissue around the ankle region. Why are the soft-tissues a concern with tibial plafond fractures? Because there is little muscle and skin surrounding the ankle joint, severe fractures of the tibial plafond can be problematic. If the soft-tissues are too swollen and damaged, surgery may not be possible through these damaged tissues. In these cases, definitive surgery may be delayed until the swelling subsides and the soft-tissue condition improves. While the soft-tissue is healing, the fractured bone and ankle joint will be immobilized. This may be done with the use of a cast, splint, or external fixator. An external fixator is a device placed surgically around the soft-tissues that are swollen and damaged. The external fixator secures the bone both above and below the fracture, while avoiding the soft-tissue that requires healing. The advantage of the external fixator is that is holds the bones rigidly immobilized and allows your surgeon to monitor the soft-tissue healing. What is the definitive treatment of tibial plafond fractures? Once the soft-tissues will allow definitive treatment, there are several options available in the treatment of tibial plafond fractures.

Casting Casting is used in patients who have minimal displacement of the fracture fragments. Casting may be favored in patients who have significant soft-tissue injury when surgery may not be possible. External Fixation External fixators are used for fixation in fractures that have significant soft-tissue damage. These may include open fractures, or fractures with swelling that would not allow your surgeon to make incisions in the tissue. External fixators can either be used temporarily until the soft-tissue condition improves, or for final treatment of the tibial plafond fractures. Limited Internal Fixation Limited internal fixation has become a popular option for patients who would benefit from surgery, but have softtissue concerns for surgery. In this case, small incisions are used to secure fracture fragments, and this treatment is augmented with the use of a cast or external fixator. This type of treatment bridges the gap between the more and less invasive treatment options. Internal Fixation Internal fixation of tibial plafond fractures can allow excellent restoration of the alignment of fracture fragments. Unfortunately, even with the bone fragments lined up well, ankle arthritis can result following these fractures. This so-called 'post-traumatic arthritis' is due to the cartilage damage sustained at the time of injury. Ankle Fusion Ankle fusion is reserved for the most severe fractures that have little hope of restoring a functional ankle. The advantage of an ankle fusion is that is can provide a stable walking platform that has minimal pain.