The knee joint is the largest weight-bearing joint in the body. Three bones comprise the knee joint: the thighbone (femur), the shinbone (tibia) and the kneecap (the patella). Ligaments hold the bones together and act as backstop or restraint against abnormal movements.
Tibial plateau fractures
These are periarticular (involving the knee joint) fractures that are seen following a direct, traumatic force to the knee. Tibial plateau fractures are commonly seen in skiers and snowboarders. In addition, these fractures may be associated with soft tissue injuries, such as ligament and/or meniscus tears. Complications from a tibia plateau fracture can include posttraumatic arthritis, joint stiffness, knee instability, muscle weakness and chronic pain.
Tibial shaft fractures
Tibial shaft fractures are more common than tibial plateau fractures. These fractures involve the middle of the tibia (shinbone), and they may be closed or open (penetrating the skin).
What causes a tibial fracture?
It can be caused by a low-energy mechanism or high-energy trauma. A low-energy injury can be caused by indirect trauma resulting in a spiral fracture. High-energy injury results from direct trauma such as a sports injury or auto accident.
High – energy trauma may result in a more complex fracture that also involves damage to the soft tissues like skin, muscles, nerves, blood vessels and ligaments that connect the tibia to the femur and fibula. High-energy tibial plateau fractures are more likely to damage cartilage in the knee joint. The damage to the knee cartilage can alter joint alignment, contribute to arthritis, instability and loss of motion.
Soft tissue damage can lead to compartment syndrome, a serious condition that involves increased pressure in the muscle compartments that can result in muscle death.
Low-energy trauma can result from poor quality bone, which indicates the need for screening and treatment of osteoporosis.
Tibia fractures can have a profound effect on a person’s professional and personal life. Many tibia fractures require surgery.
What are the symptoms of a tibia fracture?
- Pain that worsens when attempting to bear weight
- An inability to bear weight
- Knee and/or swelling
- Deformity of the knee and/or leg
How is it diagnosed?
Dr. Godin will ask you for the details of your injury and symptoms. He will conduct a comprehensive physical exam including examining the soft tissues around the knee and an assessment of the nerves and blood vessels.
X-rays of the knee, leg and ankle will reveal the fracture and its type and extent. A CT scan will provide valuable information about the bony injury, especially the knee joint surface. A MRI may be recommended to assist in identifying potential concomitant injuries.
How is it treated?
Treatment will depend on the fracture displacement and characteristics, as well as the extent of associated injuries that are present. Non-operative treatment with a brace and weightbearing restrictions may be recommended for tibial plateau fractures with minimal to no displacement. The majority of tibia fractures, however, do require surgery.
There are a variety of minimally invasive surgical approaches and novel techniques that offer provide a range of surgical choices. The surgical approach is determined by the fracture pattern and involvement of soft tissues, blood vessels, nerves, etc.
Rehabilitation will be carefully planned based upon consideration of the degree of knee stability, bone mineral density and other patient specific factors. Early functional physical therapy is important to avoid stiffness.