Tibial Plateau Fractures - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes fractures of the tibial plateau - Schatzker classification.
Lateral tibial plateau - convex in shape and proximal to the medial plateau
Medial tibia plateau - concave in shape and distal to the lateral tibial plateau.
Screw placement from lateral to medial may have a risk of joint penetration since the medial tibial plateau is concave and distal. 50% of tibial plateau fractures are associated with soft tissue injuries such as meniscal injury (lateral meniscus tears more than the medial meniscus), medial collateral ligament injury, anterior cruciate ligament injury, and compartment syndrome. Lateral meniscal tears occur commonly with Schatzker Type II fractures (split-depressed). Medial meniscal tears occurs with Schatzker Type IV fractures (medial plateau).
Type I: pure cleavage fracture of the lateral tibial plateau. Treatment is a buttress plate - prevents collapse and shear forces.
Type II: cleavage fracture of the lateral tibial plateau with articular surface depression. Lateral meniscal tear is associated with type II fractures. Joint depression greater than 6 mm and widening of greater than 5 mm was associated with a lateral meniscal injury over 80% of the cases. Treatment is to elevate the fracture, fill the gap, plate with high compressive strength cement.
Type III: pure central depression fracture of the lateral tibial plateau with an intact osseous rim. Depression fracture that usually occurs in older populations. Treatment is to elevate the fracture, fill the gap, plate with high compressive strength cement.
Type IV: split or depression fracture of the medial tibial plateau. Possible vascular injury and medial meniscal tears are associated with Type IV fractures. The fracture produces temporary dislocation of the knee with possible popliteal artery injury. Frequent neurovascular checks, ABI and arteriography may be needed. When the fracture line extends beyond the medial eminence, it is associated with more complication such as compartment syndrome. Treatment is surgical repair (for all) A-B index for vascular complications. Vascular complications should be avoided by assessing the patient by the ankle/brachial index.
Type V: Bicondylar tibial plateau fracture with intact metaphysis and diaphysis. Treatment is surgical repair followed by internal fixation technique when the soft tissue condition permits.
Type VI; unicondylar or bicondylar tibial plateau fracture with metaphyseal-diaphyseal dissociation. Treatment is an external fixator followed by internal fixation when the soft tissue condition permits. If both sides need to be fixed, medial and lateral plate fixation should be done through two approaches.
Physical examination:
•Examine the neurovascular status of the patient
•Examine for compartment syndrome
•If varus/valgus tests demonstrate laxity of more than 10 degrees, this indicates instability and it requires surgery (this is an important point usually found on the board exam).
•Neurovascular exam
oAny differences in pulse exam between extremities should be further investigates with ankle-brachial index measurement.
Imaging
•Obtain plateau view
o10 degree caudal tilt
•Important findings
oPosteromedial fracture lines must be recognized
•CT scan is the study of choice
•MRI
oUseful to determine meniscal and ligamentous pathology
Posteromedial Fractures:
•Must be recognized
•If you see it, fix the fracture (do two separate incisions):
oLateral plate
oPosteromedial plate: fix it with a posteromedial plate placed through a separate incision between the semimembranosus and the medial head of gastrocnemius (Baker’s cyst location).
Surgery
•The aim of surgery is to restore joint stability and alignment, provide a stable fixation and achieve early return of range of motion
•Early range of motion helps maintain cartilage
•Buttress plates are used in Unicondylar fractures
•Locked plates are used more frequently in bicondylar fracture
•Superficial and deep peroneal nerve injury may occur with percutaneously placed long lateral submuscular locking plate.
•In external fixation, keep the wire of pins more than 14 mm away from the joint.
Spanning external fixation is used in:
•Ligamentous injury
•Bicondylar fractures with shortening
•Soft tissue injury
•Polytrauma
•Comminution
The outcome of surgery depends on restoring adequate stability and mechanical alignment.
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[@marksimpson7348]

I'm now 9 weeks post op i had tibia plateau type 2 fracture, 9 screws 1 plate. I used the brase the hospital gave me for 2 weeks then i left it off but was very carefull with my leg. I found that moving my leg about was easier and rom was better than expected at each review. I never told the doctor i took it off tho, From 5 weeks I started using the resistance band leg pressing and toe extension very shaky for the first few days. At 6 weeks I started using an exercise bike slow and steady first day 2.5k next day 3, then increased every day till i got to 4k then i increased the resistance as and when. By 8 weeks my leg was skinny but with some strength back. I started walking with crutches 70 to 80% weight bearing. A week later 9 weeks im walking on my own my knee feels very awkward especially when first using it once I've walked a few steps it loosens up. This injury is still early days yet but I just want to inform people that it gets easier and dont get down about it! Just get your leg strong so you have a head start

[@guitarsoundsaround]

Can you tell me what kind of knee brace you use? I’m type 2 fracture with a plate and 6 screws. 6 months in :( I’m at 96 degrees but the doc wants to see me at 110-120, and wants me to pay for a $500 per month brace that forces flexion. My PT hasn’t touched my leg once, he gives me a piece of paper with exercises and stretches and I feel so ripped off. I’m doing all my exercises on my own with a stationary bike.

[@marksimpson7348]

I'm not sure of the name of it but it had 4 or 5 straps with a meter joint at the sides of my knee

[@guitarsoundsaround]

@@marksimpson7348 wow! You are doing great - I’m at 7 months. I was misinformed, and I’m a type 5 TPF. I have had little info from the surgeon and even less from the physiotherapist. So I’m googling and YouTubing everything now. I am finally at 102 ROM. But I can tell this will be an injury that will stay with me for years, mostly the stiffness and reminder to be very careful. The stationary bike is a game changer! I think these braces are called hinged braces (2 straps on the thigh with 2 on the calf.) I was told at 6 months by the surgeon, to stop wearing the brace. Mostly to gain muscles and proper feel for weight bearing and to stop relying on the brace. I was the same, and didn’t wear it often, except outside and on the slippery icy melting snow conditions. I’m starting to feel much more pain this month with the brace on, especially at the break, so I loosened the one strap. I’m going to search for a compression brace or something that is more comfortable for support but I need to get the ROM to 120 in the next 5 weeks. I hate this injury. Keep your chin up! Some days are hard, others harder and the tiny gains are fantastic. Good luck healing too - trust yourself and be cautious. ✌️

[@raycenteno323]

Im in week 6 and its Great to hear that it gets better...

[@retiredboxingref7620]

Thanks Mark!

[@mikayln]

Some people really don't understand the nature of this injury. This was a life-changing injury that was much more painful than childbirth.

[@petrosk3031]

Mikayln 2004 agreed

[@xinixxagnix201]

y so right, a live changing rollercoaster with no ending. (s6) Good luck and hope you react more here how it goes, all the best in the world!

[@Mint_1909]

Rightly said

[@AllthebeautifulThings]

Mikayln 2004 Totally agree!!! :'(

[@vontrances4667]

hard to understand how brutal it is because from the outside all anyone visually witnesses is insane swelling

[@AllthebeautifulThings]

I'm an ice skater and I had the most stupid accident in the street and I got a tibial plateau fracture Schatzer Type VI...life changing...but thank God I'm recovering pretty well. My very best wishes for everybody who's recovering from this horrible experience!!

[@Chibibowa]

I got a Schatzker V in my left leg. Stayed 11 days in the hospital, surgery after 6 because of the swelling. I got Internal Fixations that will be removed in beginning 2020. My ligaments are safe (didn’t suffer at all by the impact). Now, 8 months after the operation (I jumped from +- 4 meters and the left leg was apparently in a locked state thus breaking severely the tibial plateau), I can do 90% of the things. But I can not run or jump on one leg. If I run, I do so in a limited speed and the movement isn’t fluid. I hope it gets better after some time. I still have 2 operations to do however, one in 2020 and an Osteotomy in 2021 because my Genu Valgum is at 7 or 8 degrees due to the fall. (I naturally have Valgum legs but the fall increased the left angle). I had a 3 hour surgery. But I appear to be recovering at an impressive speed (compared to the severity). Mostly due to my age and food regime (I like to drink about 0,5 L of milk every day) being very diverse and rich in vegetables and fruits + red meat (I also eat chicken ^^) PS: The wound was not open. So that was a good thing :-)

[@varunkashyap7106]

@@Chibibowa my condolences to you did your doc mentioned about Arthritis r u undergoing High Tibial Osteotomy

[@Chibibowa]

@@varunkashyap7106 Yes, he did. He also mentionned that for the osteotomy. And yes, it's a high tibial osteotomy. At least the wound was a high tibial one, so I assume so. Might be wrong. We didn't discuss that yet. First the next operation, which will remove the plates.

[@varunkashyap7106]

@@Chibibowa how much time he mentioned e because eventually the knee replacement is evident my friend this fracture really sucks i suffered type 2 TPF and I'm terrified from its prospects

[@Chibibowa]

@@varunkashyap7106 The knee is also fine. The only bone that broke was the high tibial plateau one (Schatzker V), he had to replace (re-set) cartilage. The knee stayed in position when I fell. There are no problems at all there.

[@abhishekbhatta2071]

Worth watching this lecture video..it made me understood where i didnt get the concept through book..now i can get it from there.

[@laurenbrown1820]

Thank you for this easy to understand video!!

[@Charlie-vj8op]

I’m 14 months post-op tpf class V. 22M and previously fit / healthy. I have 2 plates and 15 screws in my knee / leg. I made very good progress in the first 3 months but thereafter progress is very slow. I do walk normally now and have done since about 6 months. I can now walk around 5km with no limp before any discomfort. My most steps is around 20k in a day which involved many rests and soreness in the evening / next day. However I can’t jog more than 30 seconds as of yet before feeling significant discomfort, which lasts for days afterwards and affects my ankle too. I can train legs at the gym, and have squatted 60KG for reps recently with no discomfort (prev working weight was 100kg). I still have very significant muscle atrophy in my affected leg which is taking considerably longer than I expected to rebuild (my leg was immobilised for around 8 weeks). I have full flexion of the knee but around 1-2° away from full extension which will likely be permanent. Stiffness is a killer sometimes and your knee will need to be stretched out before walking after getting up after being sat for a while or after driving before standing up. My knee clicks and pops a lot but feels generally stable. Tl;dr, very serious, debilitating injury, with a long recovery time, especially frustrating for active people. Hope this helps. I tried to include things I had questions about when I initially suffered my injury. It’ll feel hopeless at times but a good recovery is definitely possible.

[@jjr1728]

Thank you for your information. I can't extend fully striaghten past say 10 degrees so it's a considerable difference. It's like I can't lock out my bad leg. Waiting on physio for this or do you think it'll never be able to fully extend?

[@deepakostwal2905]

What did you do in your recovery?

[@jjr1728]

@@deepakostwal2905 his information was so hot. Pain stories are hot

[@raycenteno323]

Im in week 6 and i started movements about week 3 just using gravity and had lots of stiffness and had about 30% bending. By week 6 now i would say i have 60 percent bending and 50percent weight Bearing i can stand and do lots of excercises my swelling its gone down about 75percent. 2 weeks out till my next Dc visit. Hope to do well and hopefully be able to walk soon

[@vandawoodman4305]

Any update on how your doing now I'm 5 weeks in can't weight bare yet stuck in bed I done both legs, I've got q compressive leg bending machine that my leg goes in when I'm in my bed I started off stiff as anything could only get 15 degrees bend my legs right now is in it and I on 65 degrees hell of a better but every morning a wake up in loads of pain and its stiffened right up again this machine is a life saver I've no idea how this is going to pan out I'm 26 so docs say I should heal well as I'm young as healthy but right now i feel my legs are so stiff and muscles have done so tight and wasted away I'm worried ill never walk again , hopefully with time I'll look back at this like it never happened even if its years down the road, just wondering how your doing 8 months on have you got an update on your recovery

[@geojor]

thank you ...

[@shahloalimhanova6325]

Thank you so much dr! May Allah good and long life 🤲🏻

[@rukiahodge3849]

Great video!!

[@lifehope1447]

Excellent

[@enanguko2237]

Thanks Prof for this detail and pearls

[@nabilebraheim]

Please disregard the spelling error. It should read SCHATZKER CLASSIFICATION.

[@xchannel.9829]

sir i was fell down from bike 5 monthes ago and got 4type right knee injury now i decided to surgery plz it will be successful or not

[@sunbalsarfraz183]

Medial meniscus injury not lateral meniscus injury is associated with type 2

[@akashbaburaj2349]

Thank you sir

[@imansallemi4603]

thanks doc ^^

[@juliebaird2219]

Dr. Ebraheim, Referring to the SCHATZKER CLASSIFICATION have you ever heard of any tibial plateau fracture, of any of the classifications, needing a full length IM Nail from hip to ankle; for a period of three years to fuse the knee before a TKA? Other than the TPF there are no fractures in the leg other than the broken knee. No femur / tibia fractures needing to be stabilized. I guess In short I'm asking would in any case of any TPF would it be necessary for a Knee Arthrodesis? Thanking you in advance for your time.

[@star1856]

Tq.... Pls do more videos

[@jsmart3054]

I’m 60 VERY active ski instructor and had a level 5 on 1/22/18 from a ski accident :’( Had external fixation for 2 weeks, then a bar with WAY too many screws: 8 under the knee, several below, NWB 12 weeks PWB another 4 weeks. despite PT to help restore flexion I developed SEVERE arthrofibrosis. Hunted down a great surgeon who performed Lysis to unlock my knee, I was able to get to 130/0 flexion/extension within 8 weeks. I ride my fat bike more than an hour without much pain, but walking and standing is VERY limitted. I feel stuck and frustrated despite working on strengthening in PT and fighting with the insurance company about the ongoing need for PT. What shoukd I do next???

[@jjr1728]

I'm here because i just had my first operation last month. Dreading what the future holds.

[@vandawoodman4305]

@@jjr1728 crashed my car on the 28th August and had this injury broke the left leg in 3 places one place being tibial plateau and the above and below the knee cap, then I done above the knee on my right leg in 6 weeks in oe right leg and 5 weeks in on my worst leg can start partial weight bearing at 6 weeks I have a leg bending machine to force my leg to bend which they let me bring home to use all muscles gave wasted away and gone so tight and stiff I feel like I've gone past a place of no return the pain and agony is excruciating even this long after, really really worried about what the future holds too but all my friends and family expect I'll be uk and walking with in 3 months and back to work but no chance I dont think, best of luck to you

[@CureWithinYourHandsDrSalem]

You can do it to get back to pre accident function, just stay optimistic and motivated and keep working for it.

[@gigatronicdeth]

I got hit by a truck on a crosswalk. I jumped up at the last second and bounced off the hood, landing 17 feet away on my left leg. My tibia plateau was completely shattered. It’s been a bit over a year now since the injury, I got the titanium rods removed a couple months ago (ouch). I’m waiting for a knee replacement surgery, then hopefully I can walk again. I don’t know if I’ll ever be able to run or walk up stairs again without great pain. It’s been a long slow recovery.

[@kerrinbadham9599]

I am so sorry to hear of your accident. I fell off a ladder in a freak accident last Monday and have a Type I I fracture. I am devastated to read of how serious this injury is.

[@emg708]

@@kerrinbadham9599 how are you doing? I believe my type is a 2. I ran into a tree sledding with my kids three weeks ago. Going to get my wrap off in a couple of days and hopefully get a brace instead of the boot I have now.

[@scott5322]

Get well soon J.J.

[@adhammohamed5087]

Medial meniscus tear is more common than lateral one because of physiological knee valgus

[@juliebaird2219]

Dr. Ebraheim, I forgot to say that the leg the doctor wants to put the full IM Nail in has a drop foot which was causing all the falls that damaged the patient's knee in the first place. Worried about this doctor's decision.

[@ahmedalsayyad2052]

dr.Nabile . EL MAGNIFICO

[@HafizahHoshni]

thank you so much!! 15/3/2022

[@selvinmathew6672]

Is there a way to avoid the crepitus that follows a type 6 fracture?

[@adammitchell3462]

I just broke my tibia plateau, I'm waiting on surgery now. Very helpful ,thanks

[@deepakostwal2905]

How are you?😊

[@adammitchell3462]

Doin great,I'm back to work and almost good as new. Thanks for asking!

[@mirandazar]

Ive had this injury and surgery. Im in month 9 now . Have come a long way , walking on my own now. Still have pain , stiffness and swelling. I also had compartment syndrome.

[@deepakostwal2905]

How r u now?

[@stalkerthescotty]

Broke mine 3 months ago told it was a significant break and needed a plate n 3 screws 3 months later I'm going back in to get a bone graft and my metal work took out and put back in cannot believe il be back to square one living hell

[@ahmedalsayyad2052]

great jop Sir

[@marywilliams7648]

During TKR a surgeon broke my tibial, how do I Sue, him or d institution, they r saying I sign a consent form so nothing can come out of it, I signed for a TKR, not to break my Tibial Plauteau

[@ohmeowzer1]

Thank you Dr I have a tibial fracture I see the surgeon on Tuesday...i am home with an immobilizer and non weight bearing.. I have a lot pain and confusions in the back of my leg..they didn't feel the need to operate right away...but I am sure I will need surgery, , ..i keep it iced and elevated and get around in a wheelchair

[@ThangPham-cw8lk]

Sorry, "Lateral Tibial Plateau: proximal to the medial plateau" What is its meaning? I don't understand this sentence

[@harpreetharpreet8864]

Schatzer classification type 1 will it bend after surgery Canwe run after it

[@carlexus3133]

It will bend with therapy. You should be able to run. Depending on what type of injury too.

[@affirmativemindset7400]

i had a tibial fracture 4 months ago now i started bleeding from infront of the tibial not from the incision the dr made but from a opening it happend on its own is it because it is infected ? please help me i am worried

[@jeffc7470]

Dude, did you die?

[@johndamper2934]

I thought i had a tibial fracture but now im not sure ha because i sidnt have plates put in...i jist had the 2 screws put in in that area....i was running when i was 14 and felt a pop in the front of my knee and fell down.....the pop disnt hurt at all. I thought a friend hit me with a rock. I fell down and felt my knee snd the bone was poking into the skin....i lay back for less than a minute and when i sit up my knee is the size of a volleyballl...i cant bend it at all....i go the the ER and they do an x ray and tell me theres a break...they were going to fly me to the nearest big city that night but the swelling was too much. Does this sound like a tibial fracture?

[@jackcumberland]

Hi I have recently got a Schatzker type 2 fracture involving the lateral tibial plateau is demonstrated with minor articular surface depression could you maybe let me know how long it will take to heal and is it a life changing injury ?

[@himansusekhar7243]

merv barnett how is your leg now ..Did you come back to your normal life after a while ?

[@nickdubey6789]

I got type 5 fracture my question is can I easily walk n run in future? It's a 15th day of surgery now I can move a leg little bit is it heling?

[@hafiznavid9290]

Hi I got type 5 fracture 15 months before and I’m still in 2 cretches

[@loadedfun4764]

My doctor said I’ll be able to hurry across the street in a yellow light but I’ll never be able to run a marathon again.

[@docrx1857]

I had type 5 fracture 10 years ago. one plate was removed after 1 year the other plate is still inside. I have constant pain and knee hurts every day all the time. Arthritis is severe. It was most deffinately a life altering injury.

[@loadedfun4764]

@@docrx1857 consider a knee replacement. My surgeon told me prior to surgery that eventually the arthritis would be so wicked I would need a knee replacement.

[@deepakostwal2905]

How r u now

[@crushthebooksdotcom6427]

Does a blood clot usually occur right after the break? I've fractured mine 3 weeks ago. Should I be ok as long as I move it enough ( my knee is in a brace but I take it off at times )

[@CP-qc1uz]

Crushthebooks dot com I have the same I only got a brace, is it okay for you now? And did you move your leg alot?

[@weekoksiang9206]

I got type 6 fracture only can bend my knee 40degree.. I'm stress ..

[@amanarneja3573]

How was your recovery??

[@mahrukhalam3682]

I got type 1 fracture in left leg, please tell how long it took you to recover of this.

[@waleedvtec6364]

@@mahrukhalam3682 I got type 6 tibial plateu fracture.. i got operated a month before... my tibia and fibula both were broken with lot of swelling and blood cloth.. i did icing for a month and then got operated... now after a month of surgery with 2 plates and 12 screws i even got a bone graft... i can feel the strength in my leg and its getting better.. i dont put weight on the operated leg while walking with the walker.. but my doctor said after 2 weeks they will allow me to put weight...

[@greenworldtamil7681]

@@waleedvtec6364 how are you?

[@bonvaicu]

I have a knee problem, could i send you the MRI result and give me your opinion?

[@petergianakopoulos4926]

He's not a radiologist.

[@jjr1728]

@@petergianakopoulos4926 radiologists only take the scans they don't do assessments - that's for the doctors to do.

[@petergianakopoulos4926]

@@jjr1728 radiologists are doctors and are the most important part of medicine today

[@jjr1728]

@@petergianakopoulos4926 A radiologist is not a doctor - at least here in the UK. It's a 3 year course. Their job is to get good scan pictures and data for doctors to make assessments on. I know this because I had a scan yesterday and asked questions when shown the image(s) and was told that the doctors make the diagnosis and determine healing status etc.

[@petergianakopoulos4926]

@@jjr1728 you are thinking of a Technologist.. then yes ..

[@rastaptc]

Poor J.J. Watt. Get well soon.

[@alisavari6624]

عطني رقمك يا دكتور ابي اكلمك

[@chuck5113]

Damn J.J.

[@abidulhoqlue1990]

Mera tibial medial features hua 2 screw lagaya kb thik huga 25 day ho gaya

[@owaisali5671]

Apki ub leg tek ha?

[@deepakostwal2905]

Ab kaise ho

[@subratapaul9998]

My injury is type 1... So can I treat this non surgical treatment?

[@varunkashyap7106]

Yes did u do it non surgical

[@durgatejag9841]

Mine too type 1 But now I can't bend my knee above 40° Do u recovered?

[@ShortStacks7]

@@varunkashyap7106 Any update on it please respond?

[@varunkashyap7106]

@@ShortStacks7 im fine but risk of arthritis is still there

[@ShortStacks7]

@@varunkashyap7106 Bhagwan sahi kary ga kuch nh hoga. Mera bhe type 1 hai mainy bhe non surgical option choose kia hai mjy 25 din hogye hai. Ap kitny din baad chal saky thy?

[@lindaguida4074]

Life doesn’t come with instructions!

[@hoangngochai3010]

schatzker . not schatzer

[@HamCubes]

Indeed, the good doctor did say, "Schatzker." And the corresponding graphic reads, "Schatzker," too.

[@nabilebraheim]

+AeroDoe yes there was a spelling error with SCHATZKER classification.

[@nabilebraheim]

+Hai Hoang yes there was a spelling error with SCHATZKER classification.

[@bradschofield9400]

schatzer