What are the dos and don'ts in the treatment of tibial plateau fracture?

Answer 1

The most important thing in treatment of a tibial plateau fracture is realizing it is there. Tibial plateau fractures are notoriously difficult to diagnose since they may not show up on an X-ray early on. Clues a tibial plateau fracture may be present include high-force mechanism of injury, more swelling than would be expected, or pain out of proportion to what you would expect on exam.

As noted, identification may be difficult, so if there is high clinical suspicion with an apparently negative plain X-ray, a CT (or MRI) may be needed to identify the fracture.

Once diagnosed, the knee should be immobilized in consult with an orthopedist. In most cases, outpatient follow up is appropriate with appropriate analgesia, immobilization and non-weight bearing until follow up is achieved.

Pitfalls: tibial plateau fractures have a higher than normal incidence of compartment syndrome given the amount of force required to fracture the tibial plateau. Keep this in mind when making this diagnosis and be alert for signs of compartment syndrome.