Tibial plateau fractures

The classification of tibial plateau fractures is based on morphological criteria according to AO/ASIF [18] and Schatzker [21] or on functional criteria according to Moore [15]. A total of 81 acute tibial plateau fractures were operated on over a 6-year period. The patient data and the operative procedure are given (not including late results). Some 6% of ligamentous lesions were treated conservatively. Bicondylar osteosynthesis was performed in 11 %, and 14 % of the operations were minimally invasive procedures. In 61.7 % the plateau was fixed by a buttress plate. Autologous cancellous bone from the iliac crest was implanted into the fracture, especially into depressed wedge fractures (Type AO/ASIF B3 or Moore Type IV). In 39.5 % of the cases a corticocancellous wedge-shaped bone chip from the iliac crest was used. Compications were rare, and no infection was observed. Most important are the soft tissue balance, the timing of surgery, choice of longitudinal incisions directly above the lesion, and a stabilization procedure which maintains blood flow and coverage of the fracture. The operative procedures are described including tibial plateau fractures in children and the management of complications. In speical situations a conservative treatment is still useful.