What are the treatment options for tibial plateau fractures?

Updated: Jul 05, 2018
  • Author: Srinivasa Vidyadhara, MBBS, DNB, MS(Orth), DNB(Orth), FNB(SpineSurg), MNAMS; Chief Editor: Thomas M DeBerardino, MD  more...
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Answer

All high-energy fractures must be immediately checked for soft-tissue integrity and impending compartment syndrome. The overall management can be one of the following:

  • Antiedema measures - Joint aspiration, rest, immobilization, compression, elevation, and other antiedema measures are advocated in patients with high-energy fractures surrounded by evidence of compromised soft tissues (eg, skin blisters, edema); limbs with features suggestive of compartment syndrome should not be treated with antiedema measures
  • Traction - This can be used as a temporary or definitive management modality; calcaneal traction can be continued during the traction mobilization treatment of selected plateau fractures without gross articular incongruity; traction is contraindicated in patients undergoing vascular repairs
  • Debridement of open injuries - Open fractures must be addressed in accordance with universal guidelines; patients optimally undergo surgical debridement of open traumatic wounds within 8 hours of injury; aggressive debridement of open fracture wounds is performed, including removal of contaminating debris and any devitalized fascia, muscle, and bone
  • Fasciotomy for impending compartment syndrome - Emergency treatment is required because a delay in treatment is directly correlated with further damage; if signs of compartment syndrome are present, four compartment fasciotomies are performed
  • Spanning external fixator - Closed fractures undergo external fixator placement on the basis of patient stability and operating room availability, unless the patient has signs of compartment syndrome; patients undergoing debridement for open fractures and fasciotomy for compartment syndrome can be treated with a temporary external fixator until the soft-tissue condition improves

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