Tibial plateau fractures

　　Tibial plateau fractures are the result of strong varus or valgus stress combined with axial load. During the injury process, the femoral condyle applies shearing and compressive stresses to the lower tibial plateau, which can lead to split fractures, depression fractures, or both. In fact, pure split fractures only occur in young people with dense cancellous bone, and only this joint surface can bear only compressive force. With age, the dense cancellous bone of the proximal tibia becomes sparse and no longer bears only compressive stress. When there is an axial compressive load, collapse or split-collapse fractures occur.

　　Some scholars believe that the integrity of one side's collateral ligament is an essential condition for the occurrence of platform fracture on the opposite side. When the varus stress is transmitted from the lateral condyle of the femur to the lateral tibial plateau, causing a fracture, the role of the medial collateral ligament is similar to that of a hinge; while when the varus stress is transmitted from the medial condyle of the femur to the medial plateau, causing a fracture, the role of the lateral collateral ligament is also similar to that of a hinge. However, with the increasing application of MRI, it has been found that the incidence of ligament injuries in patients with tibial plateau fractures is higher than previously thought. The magnitude of violence not only determines the degree of comminution of the fracture but also determines the degree of displacement. In addition, soft tissue injuries often occur, such as when the lateral plateau fracture often occurs with MCL or ACL injury, while the medial plateau fracture often occurs with LCL or cruciate ligament or peroneal nerve and blood vessel injury. Split fractures are caused by shearing stress and should be distinguished from marginal avulsion fractures and compression fractures, the latter often associated with knee joint fractures and dislocations, leading to severe instability.

　　Patellar plateau fracture patients should be treated actively to avoid complications such as malunion, post-traumatic arthritis, and knee stiffness.

　　1, Malunion

　　Since the patellar plateau is mainly composed of cancellous bone, surrounded by soft tissue, with good blood supply and osteogenic ability, fractures are easy to heal. However, due to early weight-bearing causing collapse of the medial or lateral condyle of the tibia; unstable internal fixation, defects in comminuted fractures, insufficient bone grafting causing malunion, when genu valgus is greater than 5°, varus is greater than 15°, patients may experience pain when walking.

　　2, Post-traumatic arthritis

　　The incidence of traumatic arthritis after patellar plateau fractures is still not very clear. However, many scholars have confirmed that joint surface roughness and joint instability can lead to post-traumatic arthritis.

　　3, Knee stiffness

　　Limited knee joint movement is common after patellar plateau fractures. This difficult-to-treat complication is due to damage to the extensor mechanism, joint surface damage due to primary trauma, and soft tissue exposure during surgery. Postoperative immobilization further worsens these factors, and generally, immobilization time exceeding 3-4 weeks often causes some degree of permanent joint stiffness.

　　Patellar plateau fracture patients may experience swelling, pain, and limited movement in the knee joint after injury, due to intra-articular fracture, most patients have intra-articular hematomas. It is necessary to inquire about the patient's history of injury, whether it is an external or internal injury. Pay attention to check for collateral ligament injury, especially in patients with double-focal comminuted fractures and single-focal fractures, where the collateral ligament injury is on the opposite side, and the tender point of the collateral ligament is the site of injury. In patients with ligament rupture, the lateral stability test is positive, and clear anteroposterior and lateral X-ray films of the knee can show the fracture situation. Patellar plateau fractures are generally divided into 6 types:

　　Type I: Simple trapezoidal or split fracture of the lateral plateau.

　　Type II: Split-compressive fracture of the lateral plateau.

　　Type III: Simple compressive fracture of the lateral plateau.

　　Type IV: Medial plateau fracture, which can be split or split-compressive.

　　Type V: It includes bifocal fractures with splitting of both the medial and lateral platforms.

　　Type VI: It involves both articular surface fractures and metaphyseal fractures, with the condyle of the tibia separating from the shaft, which is known as metaphyseal-diaphyseal separation. Typically, patients have relatively severe joint destruction, comminution, compression, and condylar displacement.

　　There is no effective preventive measure for patellar plateau fractures. It is necessary to take good safety precautions in daily life to reduce accidental injuries, which can play a certain preventive role. In addition, early detection, early diagnosis, and early treatment are also the key to the prevention and treatment of this disease. In case of onset, active treatment should be carried out to prevent the occurrence of complications.

　　Patellar plateau fracture patients need X-ray and CT examinations, and if there is ligament injury, magnetic resonance imaging can be performed.

　　1. X-ray examination:Routine shooting of the knee joint anteroposterior and lateral positions can show the fracture and type, and for those that are unclear, CT or MRI examination can be performed.

　　2. CT scanning and three-dimensional reconstruction:Scans of the fracture, soft tissues around the fracture, and the meniscus should be performed separately.

　　3. MRI:Patients suspected of having ligament injuries may consider MRI examination.

　　Patients with tibial plateau fractures should eat more vegetables rich in fiber, and eat some foods that promote gastrointestinal digestion and defecation, such as bananas, honey, etc. In the early stage, some blood-activating and blood-clotting, Qi-promoting and dispersing foods should be eaten, such as vegetables, soy products, fish soup, eggs, etc. In the middle stage, some foods that help and relieve pain, remove blood stasis, regenerate new tissue, and reinforce bones and tendons can be eaten, such as bone soup, Panax notoginseng chicken stew, animal liver, etc. In the later stage, more tonifying the liver and kidney, invigorating Qi and nourishing blood, relaxing tendons and collaterals can be eaten, which can help the formation of callus, such as mother chicken soup, pork bone soup, sheep bone soup, etc. Patients should not blindly supplement calcium.

　　The treatment methods for tibial plateau fractures are divided into surgical treatment and non-surgical treatment. The specific treatment methods are as follows:

　　Firstly, Non-surgical Treatment

　　1. Indications: Tibial plateau fracture without displacement or fracture collapse

　　2. Traction method: calcaneal traction, weight 3 to 3.5 kilograms, and joint puncture, aspiration of joint hematoma, traction period 4 to 6 weeks. Relying on the traction force to make the knee ligaments and joints tense, indirectly pull and correct the displacement of the fracture, correct varus or valgus angulation, and actively exercise knee joint activity during traction. This can make the knee flexion reach 90° and shape the joint.

　　3. Arthroscopic assistance for reduction and fixation: The technique of arthroscopic assistance for reduction and fixation is beginning to be used. Arthroscopic surgery has less soft tissue damage, provides better joint surface exposure, and can diagnose and treat associated meniscus injuries. Early postoperative CPM passive activity exercise function begins.

　　Secondly, Surgical Treatment

　　If the articular surface collapse of the tibial plateau fracture exceeds 2 millimeters, and the lateral displacement exceeds 5 millimeters; if there is knee ligament injury and varus or valgus over 5°, surgical treatment should be adopted.