Tibial plateau fractures occur when a varus or valgus force is combined with axial loading on the knee. They can be classified using the Schatzker or Hohl and Moore systems. Treatment goals are to restore articular congruity, axial alignment, joint stability, and functional motion. Operative treatment is indicated for open fractures, fractures with vascular injuries, displaced bicondylar fractures, and lateral fractures causing instability. Prognosis depends on the degree of articular depression, separation of condylar lines, comminution, and soft tissue integrity. Surgical techniques include various approaches to reduce and fixate the fracture using plates, screws, K-wires or external fixation. Postoperative care involves

1. TIBIAL PLATEAUTIBIAL PLATEAU
FRACTURESFRACTURES
Angga Fiandana

2. Surgical Anatomy

3. Surgical Anatomy

4. Mode of
injury
Varus or valgus force
combined with axial
loading

5. Classification
SCHATZKER
HOHL AND MOORE

6. Classification : SCHATZKER

7. Classification : HOHL AND MOORE

8. Treatment
Non Operative
Operative

9. Treatment : Goals
1. restoration of articular congruity,
2. axial alignment,
3. joint stability,
4. functional motion.

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

12. Treatment : Operative

13. Treatment : Operative
Fixation :
1. External Fixator
2. Screw
3. Plate : L plate or T plate
4. K wire

14. SURGICAL TECHNIQUE

15. Positioning

16. Surgical Approach

17. Surgical Approach
 Anterolateral approach
 Anteromedial approach
 Universal Approach
 Posterior Approach

18. Anterolateral Approach

19. 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

20. Postoperative Care
 Position : elevated limb
 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

21. Complication
 Early : compartment syndrome
 Late :
1. Joint stiffness
2. Deformity
3. Osteoarthritis

22. THANK YOU