4 This commonly leads to blistering of the skin and in some cases dermal and even muscle necrosis. 3 The oedema and inflammation associated with the trauma can easily lead to local venous compromise, dermal hypoxia, and additional soft-tissue injury. One should think that the fracture will not change but soft tissue will, and therefore, especially in high-energy injuries, fractures should be considered as ‘substantial soft-tissue injuries with a broken bone inside’ ( Fig. Soft-tissue damage in fractures around the knee is of critical importance. What is the state of the soft tissues surrounding the fracture? Treatment strategy for tibial plateau fractures: an update. Some authors have also suggested that primary total knee arthroplasty could be an option in specific patients and with specific fracture patterns.Ĭite this article: Prat-Fabregat S, Camacho-Carrasco P. To achieve this, it is necessary to reduce and fix them through specific posterolateral or posteromedial approaches that allow optimal reduction and plate/screw placement. The ORIF strategy should also include the optimal reduction of the articular surface.Īnterolateral and anteromedial surgical approaches do not permit adequate reduction and fixation of posterolateral and posteromedial fragments. EFMO can be related to suboptimal articular reduction however, outcome analysis shows results that are equal to, or even superior to, ORIF. Complex articular fractures can be treated by ring external fixators and minimally-invasive osteosynthesis (EFMO) or by ORIF. Open reduction and internal fixation (ORIF) is the gold standard treatment for these fractures. Partially articular factures can be treated by minimally-invasive methods and arthroscopy is useful to assist and control the fracture reduction and to treat intra-articular soft-tissue injuries. Limb alignment and articular surface restoration, allowing early knee motion, are the main goals of surgical treatment. Typically the Schatzker or AO/OTA classification is used, but the concept of the proximal tibia as a three-column structure and the detailed study of the posteromedial and posterolateral fragment morphology has changed its treatment strategy. But one should remember that any type of tibial plateau fracture can present with soft-tissue complications. Sequential (staged) treatment (external fixation followed by definitive osteosynthesis) is recommended in more complex fracture patterns. These fractures usually have associated soft-tissue lesions that will affect their treatment. They principally affect young adults or the ‘third age’ population. Tibial plateau fractures are complex injuries produced by high- or low-energy trauma.
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