What is the tibial plateau?
The tibial plateau corresponds to the superior articular surface of the tibiaThe femur rests on this area. It directly participates in transmitting the body's weight and in the flexion-extension movement of the knee. This area is covered with cartilage and is a key element of the joint. Any fracture in this area can therefore have significant consequences for the mobility, stability, and cartilage of the knee.
A tibial plateau fracture is a serious knee injury, most often resulting from significant trauma. It affects the upper part of the tibia, an area essential for the stability and proper function of the knee joint. This fracture is considered a orthopedic emergencybecause it can permanently compromise mobility if it is not diagnosed and treated quickly.
How does a tibial plateau fracture occur?
A tibial plateau fracture most often occurs during a high-energy trauma, but it can also appear after a more moderate shock in some people.
The most frequent circumstances are:
- fall with landing on the knee
- skiing accident
- road traffic accident
- direct impact on the knee
- trauma involving compression and rotation of the knee
In people with weakened bones, a less violent trauma can be enough to cause a fracture.
Why is this fracture particularly serious?
Unlike a simple bone fracture, a tibial plateau fracture is often intra-articularThat is, it directly touches the surface of the knee. It may be accompanied by:
- bone depression
- fragment displacement
- cartilage lesions
- ligament or meniscus damage
Without prompt treatment, the risk of functional sequelae is high.
Symptoms of a tibial plateau fracture
The symptoms are usually immediate and marked, although they can sometimes be underestimated.
The pain is often intense, localized to the knee, and aggravated by any weight-bearing. It makes walking very difficult, if not impossible. The knee swells rapidly, sometimes significantly, indicating joint effusion or internal bleeding.
The patient may also experience a feeling of instability, a visible deformity of the knee, or a complete inability to move the joint. In some cases, the pain is so severe that the knee cannot be bent or straightened.
Tibial plateau fracture: when to seek emergency medical attention?
Any suspicion of a tibial plateau fracture requires a emergency consultation, without delay.
You should consult a doctor immediately if:
- the pain is intense after a trauma
- the knee swells rapidly
- support is impossible
- the knee appears deformed
- Mobility is very limited
- the trauma is recent and violent
This type of symptom clearly corresponds to a knee emergency requiring rapid specialist evaluation.
The first steps to take before the consultation
While waiting for medical attention, certain actions can help limit complications.
It is essential to Do not put weight on the injured leg. and to keep the knee at rest. Applying cold helps reduce swelling and relieve pain, with several applications daily, without direct contact with the skin.
The leg can be slightly elevated to reduce swelling. However, it is not recommended to force the knee to move or to try to "walk through the pain," as this could worsen the fracture.
How is the diagnosis made?
The diagnosis is based primarily on clinical examination, but imaging is essential.
There knee x-ray is performed as a first step to confirm the fracture. However, it is not always sufficient to assess the complexity of the injuries.
A scanner (CT scan) is very often necessary in order to analyze precisely:
- the number of fragments
- bone displacement
- tibial plateau depression
- joint damage
MRI may be indicated to look for associated lesions of the ligaments, menisci or cartilage.
The different types of tibial plateau fractures
There are several forms of fractures, ranging from simple non-displaced fractures to complex fractures with bone impaction and bursting.
Some fractures are stable and minimally displaced, while others are unstable and directly compromise joint congruity. This distinction is crucial, as it determines the treatment.
What injuries might be associated?
Tibial plateau fractures are frequently associated with other knee injuries, including:
- meniscal lesions
- ligament ruptures
- bone contusions
- damage to articular cartilage
These associated lesions can worsen the prognosis if they are not identified and treated.
Treatment of tibial plateau fracture
Treatment depends on several factors: the type of fracture, its displacement, the condition of the cartilage, and the patient's functional expectations.
Non-surgical treatment
It can be considered when the fracture is stable and undisplaced. It relies on temporary immobilization, prolonged non-weight-bearing, and close radiological monitoring, combined with progressive rehabilitation.
surgical treatment
Surgery is often necessary when the fracture is displaced, unstable, or depressed. Its aim is to restore the joint surface, stabilize the bone, and allow for optimal functional recovery.
Early surgical intervention is crucial to limiting the risk of secondary osteoarthritis.
What are the possible complications?
Without appropriate treatment, a tibial plateau fracture can progress to:
- chronic pain
- knee stiffness
- joint instability
- early osteoarthritis
- lasting limitation of walking
These complications explain why this fracture should never be taken lightly.
Why is specialized care essential?
A tibial plateau fracture is a complex injury that requires a specific knee expertiseRapid intervention allows for:
- an accurate diagnosis
- an appropriate therapeutic strategy
- prevention of after-effects
- optimized functional recovery
