1: Clin Orthop  1993 Jul;(292):87-100 

Tibial plateau fractures. Management and expected results.

Tscherne H, Lobenhoffer P.

Trauma Department, Medizinishce Hochschule Hannover, Federal Republic of
Germany.

The objective of treatment of tibial plateau fractures is precise reconstruction
of the articular surfaces, stable fragment fixation allowing early motion, and
repair of all concomitant lesions. A classification scheme is employed to
include the high incidence of concomitant lesions in specific fracture types.
The term "complex trauma" is used for extensive injuries involving multiple
structural elements of the knee joint. Exact grading of the soft-tissue injury
is crucial for the treatment plan. The authors suggest a four-grade
classification system of closed and open soft-tissue injury. Preferred treatment
is open reduction and internal fixation (ORIF) in all displaced and unstable
tibial plateau fractures. A stepwise approach is used in complex knee trauma.
Primary treatment includes closed reduction, wound debridement, if necessary,
and external fixation of the femur and lower leg ("transfixation"). Open
reduction and internal fixation and complex bone and soft-tissue reconstructions
are performed in a second operation after recovery of the soft tissues. A
follow-up study of 190 of 244 cases of tibial plateau fractures treated in the
authors' institution from 1981 to 1987 showed good results after operative
treatment, even in extensive fractures, with a tolerable complication rate. The
functional recovery was relatively impaired in multiple injured patients and in
complex knee trauma.

Publication Types:
Review
Review, Tutorial

PMID: 8519141 [PubMed - indexed for MEDLINE]