10. Treatment : Operative
The absolute indications :
1. open tibial plateau fracture
2. a tibial plateau fracture combined with vascular
lesion.
The relative indications :
1. most displaced bicondylar fractures
2. displaced medial condylar fractures
3. lateral plateau fractures that result in joint
instability.
11. Prognosis
Four primary factors determine the prognosis
1. the degree of articular depression;
2. the extent and separation of the condylar
fracture lines;
3. the degree of diaphyseal-metaphyseal
comminution and dissociation
4. the integrity of the soft tissue envelope
17. Surgical Approach
o The flaps that are raised must be full
thickness, consisting of the subcutaneous
fat down to the fascia.
o The meniscus must be preserved and should
never be excised to facilitate exposure.
Submeniscal arthrotomy should be
performed to gain visualization of the
articular component
o Bone graft should be considered for
depressed fracture
18. Postoperative Care
Position : elevated limb, flexion knee
45º - 60º
Movement : as soon as possible
Non weight bearing for 10 – 12 weeks
X ray monitoring : after 6, 10, 16
weeks, and prior to implant removal
Plate removal 12 – 18 months
19. Complication
Early : compartment syndrome
Late :
1. Joint stiffness
2. Deformity
3. Osteoarthritis
