Right at the base of your knee, there is a flat portion of the shinbone called the tibial plateau. The tibial plateau is the flat, upper part of your shinbone that supports your knee joint. When it’s fractured, it can cause big trouble for your entire leg. A strong impact, like a fall from a height or a car accident, can easily fracture your tibial plateau. With a tibial plateau fracture, you won’t be able to put weight on your leg without severe pain. Simple activities like walking, climbing stairs, or even standing for a long time will feel impossible.

This part of your leg is integral for allowing your knee to have the stability and movement that it needs to carry your bodyweight while you walk. It needs medical care and precious time to heal to ensure you regain full function of your leg. Though it might sound like an uncommon injury, tibial plateau fractures are more frequent than you might think. They account for about 1% of all fractures, but their impact on your mobility can be significant.

At Well Health Pro, we are determined to make sure you receive the right treatment for your condition. Not only will we educate you about how to best manage the condition but we will guide you on your journey to full health. Tibial Plateau fractures are serious knee injuries but with the correct guidance and treatment, we will make sure you achieve your goals and get back to your everyday life to do the things you most enjoy!

In order to understand the diagnosis and treatment of a tibial plateau fracture, it is important to understand the basic anatomy. The structures that are affected by the condition are as follows:

Tibial Plateau

The tibial plateau is the flat, top surface of your shinbone, right below your knee. It’s like the tabletop of your leg, providing a level surface for your femur, or thighbone, to rest on.

Shinbone (Tibia)

This is the larger of the two bones in your lower leg, running from your knee to your ankle. It’s like the main support beam of your leg, holding up your body’s weight.

Knee Joint

This is the junction where your thigh bone (femur) and shinbone (tibia) meet. It’s the pivot that allows your leg to bend and straighten. The tibial plateau is an essential part of this joint, acting as the platform that supports the entire mechanism.

Muscles Supporting the Tibial Plateau

There are a few muscles that are supporting the tibial plateau and which make the movement of the knee possible. These muscles are the following:

• Quadriceps – This group of muscles at the front of your thigh is responsible for straightening your knee.
• Hamstrings – Located at the back of your thigh, these muscles help bend your knee.
• Calf Muscles – These muscles help in lifting your heel and play a role in stabilizing the knee.

Ligaments Providing Stability

The ligaments around the tibial plateau are like the ropes that hold a tent in place. It does this by providing passive stability to the knee joint. These include:

• Medial Collateral Ligament (MCL) – It runs along the inner side of your knee and prevents too much inward movement of the knee joint.
• Lateral Collateral Ligament (LCL) – It is located on the outer side of your knee and prevents too much outward bending of the knee joint.
• Anterior Cruciate Ligament (ACL) – This ligament is plays its role in preventing the tibia from moving too far forward in relation to the femur.
• Posterior Cruciate Ligament (PCL) – Opposing the ACL, this ligament works in the by preventing the tibia from moving backwards in relation to the femur.

Stability and Support

The tibial plateau is like the foundation of a building for your knee joint. It provides a stable and level surface for the femur (thigh bone) to rest on, ensuring smooth and controlled movement. It also acts as a shock absorber. It is able to distribute the weight and forces that travel through the leg.

Leg Movement

Without a healthy tibial plateau, simple actions like walking, running, or jumping become nearly impossible. The muscles and ligaments that attach to the tibial plateau need a strong base to work from. Without a strong foundation like the tibial plateau, the muscles will not be able to perform their functions. For example, your quadriceps muscle, which helps extend your knee, attaches on the front edge of your tibial plateau. If this is damaged, the quadriceps will struggle to extend your knee.

Impact Resistance

Think of the tibial plateau as the bumper of a car. It helps absorb and distribute the forces that your knee encounters during activities like running or jumping. This part of your knee is quite strong on its own. It is able to handle strong forces and will usually not break with everyday activities or accidents.

The Impact Moment

Imagine you’re engaged in a high-impact activity like skiing or playing soccer, and suddenly, you take a hard fall or collide with another player. The force from such incidents can drive your thigh bone (femur) directly into your tibial plateau, causing a fracture. This is one of the most common ways that a tibial plateau fracture occurs. Imagine striking a hammer into wood and it leaves a crack. Another frequent scenario is a car accident, where your bent knee slams into the dashboard. The force of this impact can also lead to a tibial plateau fracture. It’s similar to applying a sudden, strong pressure on a structure until it gives way.

The Support Network

Our knee is supported by a network of soft tissues, including ligaments and cartilage, that act like the glue and lubricant, holding the bones together. When there’s a tibial plateau fracture, this “glue” can be compromised.

What Happens at the Fracture Site

With a tibial plateau fracture, a couple of physiological changes occur in your body that eventually lead to the pain and discomfort you will experience. This is how it will look:

• Inflammation: Just like when you get a bruise, and you see redness and swelling, that’s what’s happening around your knee. Inflammation is one of the ways your body starts the healing process, but it also makes the area stiff, swollen, and more painful.
• Muscle Spasm: The muscles around the knee might contract involuntarily in response to the injury. While this is your body’s way of protecting the area, these spasms can cause significant pain and limit your ability to move your leg.
• Ligament Sprain/Tear: The ligaments, which are like strong bands holding the bones together, might be stretched or even torn. Imagine overstretching a rubber band to the point where it loses its shape or breaks. A torn ligament can lead to instability in the knee, as well as pain.

All of these factors work together to produce the pain that you will feel in the case of a tibial plateau fracture. Understanding all three can help in finding appropriate treatment and managing the pain effectively.

• Falls: A common cause of tibial plateau fractures is falling from a height or slipping and landing heavily on your feet. The impact can drive your femur into the tibial plateau, leading to a fracture.
• Sports: Athletes, particularly those involved in high-impact sports like skiing, soccer, or basketball, are at a higher risk. A sudden twist of your knee or a direct blow to your knee during these activities can result in a fracture.
• Motor Vehicle Accidents: The force of a car or motorcycle crash can cause your knee to smash against the dashboard or other hard surfaces. This may lead to a tibial plateau fracture.
• Osteoporosis: Individuals with weakened bones due to osteoporosis are more susceptible to fractures, including those of the tibial plateau, even from minor falls or impacts.

Since this is injury is quite severe, a classification system is used to determine how bad the injury really is. This system is called the Schatzker classification system. The injury becomes more severe as the number type increases.

Mild

• Schatzker Type I (Wedge Fracture): This is a split or wedge fracture of your lateral tibial plateau. You might experience pain and swelling, but the displacement is minimal, and the knee joint remains relatively stable.
• Schatzker Type II (Split Depression): This involves a split fracture of your lateral plateau with a depressed fragment. There’s more noticeable pain and swelling compared to Type I, and there might be some instability in your knee.

Moderate

• Schatzker Type III (Pure Depression): The lateral tibial plateau is depressed without any splitting. Significant pain and swelling are present, and you might notice some instability when bearing weight on your leg.
• Schatzker Type IV (Medial Plateau Fracture): This is a fracture of the medial tibial plateau. It’s less common but considered more severe due to the higher forces needed to cause it. There’s severe pain, swelling, and potential knee instability.

Severe

• Schatzker Type V (Bicondylar Fracture): Both the medial and lateral plateaus are fractured, leading to significant knee instability. You’ll likely experience intense pain, severe swelling, and a visible deformity in your knee.
• Schatzker Type VI (Metaphyseal-Diaphyseal Disassociation): This is the most severe type, involving a fracture that extends from your knee joint into your tibia’s shaft. Extreme pain, swelling, and an apparent deformity are present, along with a high risk of knee instability and soft tissue damage.

As experienced physiotherapists, we are dedicated to using a comprehensive and methodical approach to diagnose your tibial plateau fracture. Our objective is to accurately assess the extent of your injury and develop a customized treatment plan that aligns with your rehabilitation goals.

The diagnostic process begins with a detailed exploration of your symptoms, including their onset, intensity, and factors that make them worse or better. Following this, we conduct a thorough physical examination of your knee, which includes:

• Palpation: We carefully examine the area around your knee for tenderness, swelling, or warmth. This helps us determine whether the pain is coming from the bone, muscle or joint.
• Range of Motion Assessment: We assess the mobility of your knee, along with the flexibility of the surrounding muscles. This allows to identify any limitations or imbalances that you may have.
• Strength Testing: We evaluate the strength of your knee, thigh, and calf muscles to detect any imbalances that could contribute to making your condition more difficult than it should be.
• Special Tests: We employ specific clinical tests designed to elicit your symptoms, assisting in the confirmation of a tibial plateau fracture and distinguishing it from other conditions. These tests may include the McMurray test, the Lachman test, and the Anterior Drawer test.

Based on the findings, your physiotherapist will discuss the most suitable treatment plan to treat your tibial plateau fracture. At Well Health Pro, we are determined to support you on your journey to recovery and help you return to a pain-free and active lifestyle.

X-rays are usually the first step in diagnosing tibial plateau fractures because they can clearly show breaks in the bone. However, X-rays might not always show small cracks or the exact details of the fracture. In these cases, we might use other imaging methods, like CT scans or MRI, to get a better look at the injury.

Your physiotherapist can refer you to get x-rays taken if necessary.

CT scans are useful in diagnosing tibial plateau fractures when X-rays are not enough. They provide detailed images of the bone and can show the extent and complexity of the fracture. This is important for planning surgery and understanding how severe the injury is. CT scans can also help spot other injuries in the knee that might have been missed on an X-ray.

If you need an ultrasound, your physio will refer you.

MRI is not typically the first choice for diagnosing tibial plateau fractures, as it’s better at showing soft tissue injuries than bone fractures. However, MRI can be very useful in certain cases. It can help see if there are any injuries to the ligaments, meniscus, or cartilage in the knee, which can happen along with a tibial plateau fracture. MRI can also show small fractures that might not be visible on X-rays or CT scans.

If your physiotherapist suspects anything more than just a muscle spasm, you will be referred to the right specialist.

Improper Healing and Chronic Inflammation

The affected area may not have fully healed. Since the area is not fully healed, it may lead to continued discomfort and pain since your tibial plateau has not healed properly. This inflammation can result in the formation of scar tissue, which can limit movement and cause discomfort in your knee.

Complications and Muscle Imbalances

A tibial plateau fracture is quite a serious injury and usually does not injure on its own. Other injuries or conditions, such as ligament tears or arthritis, might have developed. Over time these conditions may develop because the muscles supporting your knee were not strong enough to stabilize the joint. This underlying weakness is putting you at risk of developing other painful conditions in the future.

Improper Treatment and Underlying Conditions

The initial treatment might not have addressed the root cause or severity of the fracture. Not only may improper treatment affect the recovery of your knee, but there may also be other factors, such as diabetes, osteoporosis, or rheumatoid arthritis, that you might not have considered.

Joint Instability and Arthritis

If the fracture caused damage to the cartilage or led to misalignment of the knee joint, it could result in joint instability. Over time, this instability can increase the risk of developing post-traumatic arthritis, which can cause chronic pain and stiffness.

Delayed Union or Non-Union

In some cases, damaged bone pieces may not heal at all (non-union or heal later than expected (delayed union). As a result, the person may be in constant pain, be unstable, and need more treatments or surgery.

Waiting too long

With time, the inflammation and pain around the knee can worsen, making the recovery process more difficult. This can lead to a chain reaction, causing other areas of the leg to become sore and overworked.

Not using protective gear properly

After a tibial plateau fracture, it’s important to use a brace or cast correctly. It is rare, it injure the tibial plateau on its own without injuring the supporting ligaments of the knee. A brace will provide the necessary stability for you to use your knee safely. However, using it for too short or too long can lead to poor healing or cause the knee to become weak and dependent on the support.

Treating the wrong problem or not completing treatment

Getting the right diagnosis from the start is essential. Without it, you might waste time and delay proper treatment. If you don’t stick to your treatment plan, your knee won’t heal properly. It’s important to follow through with a complete and consistent treatment plan.

Rest and pain medication alone won’t solve the problem

While medication can help with pain, it doesn’t fix the root cause of a tibial plateau fracture. Balancing rest with safe movement is key. Stretching alone won’t fix the problem, and you need a guided exercise program that works different muscle groups. Too much rest can lead to weakness and stiffness, while too little can keep the inflammation going.

Ignoring weight-bearing restrictions

After a fracture, your doctor might tell you to keep weight off your injured leg. Ignoring this advice can slow down healing or even make the fracture worse.

Skipping rehabilitation exercises

Physiotherapy is a big part of healing from a tibial plateau fracture. If you skip your exercises, you might end up with a stiff, weak knee that doesn’t work as well as it should.

As experienced physiotherapists, we understand that a tibial plateau fracture is a challenging injury to recover from. We want to assure you that together, we can create a treatment plan to guide you through recovery. It will include a combination of techniques designed to reduce your pain and inflammation, and to improve your knee mobility and strength.

• Manual therapy: Hands-on techniques, like soft tissue mobilization and joint mobilization, to decrease your pain and increase your range of motion.
• Therapeutic exercises: We’ll work together on targeted exercises to strengthen and stretch the muscles around your knee.
• Activity modification: Initially, we guide you to modify your daily activities and exercise to minimize stress on your knee.
• Pain management and Education: Giving you the information you need to understand your pain, helps with long-term pain relief. We can advise you on different pain-relief strategies.

• Gait retraining

  : We’ll help you improve your walking pattern to ensure proper weight distribution and reduce the risk of further injury.

• Functional training: As you progress, we’ll introduce exercises that mimic your daily activities or sports to ensure a safe return to your normal routine.
• Other effective modalities: We will also use pain management techniques such as Dry Needling and Electrotherapy that has been proven to manage pain. Bracing can also be used to protect the injured area so that the fracture may heal properly.

The goal is to help you get back to your daily life and exercise routine as soon as possible, while minimizing the chances of the long-term complications of tibial plateau fractures.

The healing times for tibial plateau fractures can vary depending on the severity of the fracture and the individual’s overall health. Generally, the bone healing process for a tibial plateau fracture can take about 3 to 6 months. During this time, it’s important to follow a physiotherapy protocol to support healing and regain function.

In the initial two weeks post-injury, physiotherapy treatment is typically recommended twice a week to manage pain, reduce swelling, and maintain joint mobility. As healing progresses, the frequency of treatment sessions can be adjusted based on your recovery and specific needs.

It’s important to note that while the bone may heal within a few months, a full recovery and return to sports or high-impact activities can take longer, often around 4 to 6 months or more. This extended period allows for the gradual rebuilding of strength, stability, and mobility in the knee.

For non-operative treatment of tibial plateau fractures, a conservative approach is taken, focusing on protecting the fracture site and supporting the body’s natural healing process through immobilization, controlled weight-bearing, and physiotherapy. This approach aims to achieve healing without the need for surgery.

• Pain Medication: Prescribed by your doctor, these can effectively manage pain and swelling. However, they may have side effects and do not address the underlying injury.
• Chiropractic Care: Can help with alignment issues due to changes in gait or posture. While it can provide relief, it may not directly improve the fracture and could potentially worsen the condition if not applied carefully.
• Biokinetics: Offers sport-specific training for later rehabilitation stages, aiding a safe return to sports. However, it’s not suitable for the initial healing phase and requires a skilled practitioner.
• Knee Bracing: Provides support and stability in the early stages. The downside is that prolonged use can lead to muscle weakness.
• Stretching and Foam Rolling: These can offer temporary muscle relief but should be part of a larger rehab plan. Overuse or incorrect application could exacerbate pain or cause injury.

Surgery for a tibial plateau fracture is considered when the bone is badly broken, and pieces have moved out of place, making it hard for the knee to work properly. It’s also an option if the injury affects the stability and alignment of the knee joint.

In the surgery, the doctor will make a cut near the knee to see the broken bone. They’ll then move the pieces back into the right position. To keep everything in place, they might use metal screws, plates, or rods. After the surgery, the knee will need time to heal, and you’ll likely need physical therapy to get your strength and movement back.

The goal of the surgery is to fix the bone so that your knee can move smoothly and support your weight without pain. It’s important to follow your doctor’s instructions after surgery to help your knee heal well.

• Meniscus Tear: Pain localized to inner or outer knee, worsens with twisting/squatting. Tibial plateau fractures have pain/swelling at the top of the shinbone.
• Ligament Injury (e.g., ACL/MCL tear): Causes knee instability, especially during direction changes. Tibial plateau fractures involve pain/swelling just below the knee joint.
• Patellar Fracture: Pain/swelling at the front of the knee, over the kneecap. Tibial plateau fractures present with pain/swelling at the top of the shinbone.
• Osteoarthritis: Gradual onset, joint stiffness, and chronic pain worsen with activity. Tibial plateau fractures have acute pain/swelling following an injury.
• Bone Contusion: Similar pain/swelling to fractures but less severe, no bone break. Tibial plateau fractures involve a bone break and longer recovery.

• Tibial plateau break

• Knee joint fracture
• Upper tibia fracture
• Tibial condyle fracture
• Proximal tibia fracture
• Knee plateau fracture
• Tibial table fracture