Diagnosis and Treatment Strategy in Associated Lesions of Tibial Plateau Fractures
- Pp. 131-158 (28)Francesco Saccia and Marco Dolfin
Tibial plateau fractures are associated with a broad spectrum of injuries. Associated soft tissue injuries in tibial plateau fractures can be divided as soft tissue envelope lesions, neurovascular injuries and intra-articular lesions. Careful preoperative soft tissue envelope management is important in avoiding additional injury. The neurovascular status of the extremity must be evaluated, although concomitant injuries of neurovascular structures are rare. Lesions of the ligaments and/or the menisci has been reported in several studies and may contribute, if not properly treated, to the substandard outcomes associated with this type of fractures. Traditionally, meniscal tears are reported in 20-50% cases of all the tibial plateau fractures, while ligaments lesions are reported in 10-30%. Even if the examination of knee stability and of the conditions of menisci and ligaments is not so easy, is recommended to perform a careful evaluation of the patient in order to determine associated ligamentous damage. The imaging studies routinely performed for tibial plateau fractures are plain anteroposterior and lateral radiographs and threedimensional CT, while MRI has not yet become a standard tool. The final outcome of surgical treatment may be influenced by associated lesions of the menisci or of the knee ligaments. There is a wide uniformity of behaviours in treating meniscal tears: central tears in white zone must be resected, while peripheral lesions in red zone and meniscocapsular disjunction must be repaired. Ligamentous injuries associated with bony avulsion should be acutely treated during fracture fixation; in the absence of bony avulsion, functional and residual laxity should be addressed at a later date.