A tibial plateau fracture is a break in the upper part of the tibia (shinbone), which forms the lower part of the knee joint. This type of fracture is often caused by high-impact trauma, such as a fall or car accident, and can lead to serious complications, including joint instability and arthritis. Early diagnosis and treatment are crucial to prevent long-term issues. At Palms Physiotherapy & Allied Health, we specialise in the rehabilitation and management of tibial plateau fractures to help restore function and mobility.

Tibial Plateau Fracture: Causes, Symptoms, and Treatment

What is a Tibial Plateau Fracture?

The tibial plateau is the flat, top portion of the tibia that interacts with the femur and forms part of the knee joint. A tibial plateau fracture occurs when there is a break or crack in this area, which can affect the knee's stability and function. Fractures may be classified based on their location and severity.

Causes of a Tibial Plateau Fracture

Tibial plateau fractures are typically caused by significant force or trauma, including:

• High-Impact Trauma: A fall from a height, car accidents, or sports injuries like skiing or football.

• Direct Blows: A heavy object falling on the knee or a direct hit to the knee.

• Osteoporosis: In older adults, weakened bones due to osteoporosis can result in a tibial plateau fracture from a minor fall.

• Twisting Injuries: Sudden twisting or rotation of the knee can cause a fracture, especially in individuals with weakened bones.

Symptoms of a Tibial Plateau Fracture

Symptoms may vary depending on the severity of the fracture but typically include:

• Severe Pain: Pain is usually localized to the knee area and worsens with movement.

• Swelling: Swelling around the knee joint, which may be significant.

• Bruising: Discoloration or bruising around the knee or shin.

• Limited Mobility: Difficulty or inability to bear weight on the affected leg.

• Instability: A feeling of instability or weakness in the knee joint, especially when trying to walk.

Diagnosing a Tibial Plateau Fracture

Clinical Assessment

A healthcare provider will begin by evaluating the knee for swelling, tenderness, and range of motion. They will also inquire about the injury's mechanism (e.g., fall, accident) and assess the patient’s ability to bear weight.

Imaging

• X-rays: To confirm the presence of a fracture and determine its severity.

• CT Scan: May be used to assess the fracture in greater detail, especially in complex cases.

• MRI: Useful in detecting associated soft tissue injuries, such as ligament or cartilage damage.

Types of Tibial Plateau Fractures

Tibial plateau fractures are classified into different types based on their severity and the specific bones involved:

1. Type I: A small fracture without significant displacement, typically treated non-surgically.

2. Type II: A more severe fracture with some displacement but without affecting the knee’s stability.

3. Type III: A comminuted fracture, where the tibial plateau is broken into multiple pieces, which usually requires surgery.

4. Type IV: Involves damage to the articular surface of the tibial plateau and may also include ligamentous injuries.

5. Type V: A fracture that also includes damage to the underlying bones and tissues, often requiring extensive surgical intervention.

Treatment for a Tibial Plateau Fracture

Non-Surgical Treatments

For minor or stable fractures, non-surgical treatment may be recommended:

• Rest and Immobilization: The leg is typically placed in a splint or cast to limit movement and allow healing.

• Ice and Elevation: Helps reduce swelling and pain.

• Pain Management: Over-the-counter pain relievers (e.g., NSAIDs) or stronger medications for more severe pain.

• Physical Therapy: Once healing begins, physiotherapy may focus on strengthening the muscles around the knee and restoring flexibility and mobility.

Surgical Treatments

Surgical intervention may be required for more severe fractures or fractures that involve displacement of bone fragments:

• Open Reduction and Internal Fixation (ORIF): The fracture is realigned, and metal plates, screws, or rods are used to stabilize the bone.

• External Fixation: In some cases, an external frame may be used to stabilize the tibia while the bone heals.

• Knee Replacement: In cases of severe joint damage or arthritis, a partial or total knee replacement may be necessary.

Recovery and Prognosis

• Post-Surgery: After surgery, it may take several months to regain full function of the knee. Rehabilitation with physical therapy is essential for regaining strength, stability, and mobility.

• Rehabilitation: A personalized physiotherapy program will focus on regaining knee range of motion, strengthening the muscles surrounding the knee, and ensuring safe weight-bearing activities.

• Complications: Potential complications include infection, blood clots, arthritis, or persistent knee instability.

Preventing a Tibial Plateau Fracture

While some causes of tibial plateau fractures, such as high-impact trauma, are unavoidable, there are steps that can help minimize the risk:

• Strengthen Leg Muscles: Regular exercise and strengthening of the muscles around the knee joint provide better support.

• Fall Prevention: Minimize fall risks, especially in older adults, by improving balance and using assistive devices if necessary.

• Protective Gear: In sports, using knee pads or other protective equipment can help reduce the risk of injury.

Expert Care at Palms Physiotherapy & Allied Health

At Palms Physiotherapy & Allied Health, our team of experienced physiotherapists and healthcare professionals work closely with patients recovering from tibial plateau fractures. Whether you've recently been injured or are in the recovery phase after surgery, we provide tailored rehabilitation plans to promote healing and restore knee function.

Australian Resources for Tibial Plateau Fractures

• Healthdirect Australia – Tibial Plateau Fractures Overview
  https://www.healthdirect.gov.au/tibial-plateau-fracture

• Better Health Channel – Knee Injuries
  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/knee-injuries

• Australian Physiotherapy Association – Knee Fractures and Recovery
  https://choose.physio/your-condition/knee-fractures