Fractures of the upper portion of the tibia which involve the joint surface are referred to as tibial plateau fractures. Like many other fractures, these run the spectrum from non-displaced, low energy injuries to high energy, severely displaced fractures. If the joint surface is disrupted or incongruent then surgical repair to realign and stabilize the fractures is advised. Severe injuries often require a staged approach with an external fixation device that spans the knee to allow the soft tissues around the knee time to “cool off”. This is followed by definitive internal fixation with plates and screws when the soft tissue is more amenable to a surgical incision. Some of the worst complications of these fractures occur when the surgical repair is performed too early and the soft tissue around the knee breaks down.
Surgery focuses on realigning the joint surface and holding it in place with plates and screws. Post-operative range of motion and weight bearing protocols depend on the extent of the injury and the quality of the surgical fixation.
The biggest risk after surgery is blood clots in the veins of the legs and pelvis. Most patients are treated with a low molecular weight heparin medication for the first two weeks after surgery. Most patients with tibia plateau fractures heal but the recovery process is fracture and patient dependent. Pool therapy is very useful during this time as it allows for some motion without putting stress on the surgical repair. Full recovery for most proximal tibia fractures takes 6-8 months. Some patients complain of mild irritation from the tibial plate. If this is the case, the implant may be removed after 12 months. This is an outpatient surgery and the use of crutches or protected weight bearing after surgery is not indicated.