Management of Unicondylar Tibial Plateau Fractures: A Review

Daniel Warren, BS; Grayson Domingue, MD; John T. Riehl, MD

Disclosures

Curr Orthop Pract. 2022;33(1):85-93. 

In This Article

Anatomy

The tibial plateau is composed of medial and lateral articular surfaces with the medial and lateral intercondylar tubercles (tibial spine) dividing them. The geometry of the tibial plateau is variable among individuals and plays an important role in understanding the biomechanics of the knee.[8] The depth of the medial plateau ranges from 1.2 mm to 5.2 mm with no statistically significant difference among men and women.[9] The lateral plateau has an overall convex shape but is flat at the point of articulation with the distal femur with minimal variability.[8] The posterior slope of the tibia is the angle between the perpendicular line of the tibial diaphysis and the line drawn along the tibial articular surface as seen on a lateral view.[10] Increasing posterior slope is associated with increased forward translation of the tibia with axial loading and a higher incidence of fracture dislocation and ligamentous injuries.[11,12] The posterior slope is a useful measurement, but the variability of the tibial plateau among patients is described more effectively by a measurement of the medial, lateral, and coronal slopes.[8] These measurements apply the principle used in the measurement of the posterior slope to obtain each angle. The medial and lateral slopes are measured by taking the angle between the perpendicular line of the long axis of the tibia and a line between the peak anterior and posterior portion of each plateau. A positive slope is obtained when the anterior peak is proximal to the posterior peak and the line between the two lies distal to the perpendicular line. The coronal slope is measured on an anteroposterior view and is made by the angle between the perpendicular line to the tibial diaphysis and the line between the medial and lateral aspects of the plateaus. A positive coronal slope is obtained when the lateral plateau is proximal to the medial plateau. The proximal tibia is composed of cancellous bone with 60% of the load of the knee transmitted through the medial plateau. The lateral plateau is proximal to the medial plateau and is injured more commonly.[9] The medial plateau has greater BMD, and fracture of the medial plateau tends to occur more commonly in high-energy injuries and in patients with osteoporosis.2 Blood supply to the tibial plateau derives from a periosteal network of blood vessels that are at risk in procedures that involve significant stripping of the periosteum that can cause an increased risk of delayed healing or nonunion when this network is compromised.[9,13]

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