Recovering from any fractured bone takes time and requires some form of adaptation. Recovering from a tibial plateau fracture (upper shin bone) will impact day-to-day activity for an extended time. The tibial plateau is the one of the biggest bones in the body, is the weight bearing bone in the lower leg, and directly affects the knee joint. The bone fracture also affects the knee joint and surrounding soft tissues (skin, muscle, nerves, blood vessels, and ligaments). A fractured tibial plateau must be diagnosed and treated immediately to prevent future damage to the knee joint.

Commonly known as the shin bone, the tibia is located below or distal to the thigh bone or femur.  It forms the bottom portion of the knee joint and bears 100% of the body weight during activity when someone transitions to single leg stance. This weight-bearing force can become 7 times (or more) of a person’s body weight in certain activities.

The plateau is covered with hyaline (articular) cartilage and is subject to these forces. The normal alignment of the human knee is in a slight valgus position. This alone makes the lateral tibial condyle more susceptible to injury.   If the alignment of the plateau and the femoral condyles (distal end of the femur and upper part of the knee joint) is not proper the sheer and compressive forces developed with weight bearing activity can lead to “break down” of the cartilage.  This can eventually become osteoarthritis.

Causes of a Tibial Plateau Fracture

The most common cause of a tibial plateau fracture is a valgus force with axial loading (force pushing outer knee inward). This commonly occurs in auto accidents when the flexed knee makes contact with the dashboard or in sports related injuries when the athlete lands from a jump and the knee “buckles”.  At home or at work, people could fall from a height and attempt to land on their feet.  While a fracture usually involves a high energy force, minimal or low intensity forces could lead to a fracture for an osteoporotic patient.   In the event of a high energy incident the fracture site will most likely be a crack or split in the bone and with low energy incidents the bone is usually crushed.

Over 100 years, medical professionals have developed and modified a classification system for fractures. The idea behind this and any classification system was to be able to “label” a specific fracture in a way that would indicate the type of damage that had occurred when the fracture took place.  This could then be used amongst healthcare professionals and be a guide to the treatment protocols.

Today’s classification system includes 6 different classifications of fractures of the tibial plateau.  The most commonly used system classifies the fractures by the pattern of the fracture and the fragment anatomy.

• Type I:  wedge or split fracture of the lateral condyle with no compression (depressed)
• Type II:  wedge or split fracture of the lateral condyle with compression
• Type III:  pure compression fracture of the lateral condyle
• Type IV:  fracture that involves the medial condyle
• Type V:  fracture that involves the both condyles and might include compression on both
• Type VI:  complex, bi-condylar fracture with split fragments and compression of both condyles

The treatment of these fractures usually involves a surgical procedure to “fix” the fracture and compression area and a very prolonged period of non-weight bearing (NWB) status.  Many of these patients are NWB for 8-12 weeks.

Physical Therapy for a Tibial Plateau Fracture

While physical therapy could begin immediately following the surgical procedure, most patients begin 2-3 weeks after their surgery.  It is essential for the patient to remain NWB. Premature “loading” of repaired bone can cause damage and even lead to early onset arthritis of the knee joint. Initial physical therapy treatments target range of motion, pain and swelling reduction and stimulating the neuromuscular activity of all the core and lower extremity musculature.

Core strengthening is imperative during the NWB period.  These exercises reduce low back pain that usually develops due to the NWB status and provide the stimulus for the core muscles, which are the foundation to all movement, to be prepared to control the pelvis and lower extremities.   When the x-rays indicate that the proper amount of bone healing has occurred, patients will commence upon a full-fledged strengthening program that will enable them to regain full functional capabilities.

Tibial plateau fractures are life changing and need to be properly diagnosed and treated immediately. The damage to the bone can be classified into 1 of 6 categories and following an extensive period of time when the patient will be NWB they will regain full functional capabilities providing they are put through a demanding physical therapy rehabilitation program.