Management of tibial plateau fractures: diagnostics, classification and treatment
Background: Tibial plateau fractures constitute approximately 1–2% of all skeletal injuries. These complex intra-articular injuries frequently involve significant soft tissue damage, necessitating precise anatomic reduction and stable internal fixation to facilitate early mobilization and mitigate the risk of posttraumatic osteoarthritis. Despite advancements in osteosynthesis, high complication rates persist, particularly in high-energy trauma and geriatric populations with osteoporotic bone.
Objective: This article delineates a standardized diagnostic and therapeutic algorithm for tibial plateau fractures, emphasizing the utility of the 10-segment classification system in determining surgical approaches and optimizing internal fixation strategies.
Key Points: Comprehensive diagnostics include mandatory computed tomography and magnetic resonance imaging to assess frequently associated meniscal and ligamentous injuries. The 10-segment classification facilitates precise localization of articular damage, guiding the selection of surgical exposures. Surgical options range from minimally invasive fracturoscopy to complex open reduction and internal fixation. Specific approaches described include the anterolateral, posterolateral, and enhanced medial or lateral exposures involving epicondylar osteotomy for central segment visualization. In elderly patients with advanced osteoporosis or pre-existing gonarthrosis, primary total knee arthroplasty is considered an alternative to osteosynthesis. Postoperative complications remain significant, with surgical site infections occurring in up to 45% of cases and posttraumatic arthritis reported in 60% of complex fractures.
Conclusion: Optimal clinical outcomes depend on rigorous preoperative imaging, the application of segment-based classification for approach selection, and the achievement of stepless articular reconstruction. Standardized protocols and specialized surgical techniques are essential to minimize long-term functional impairment and secondary degenerative changes.
