Tibial plateau fracture

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

Tibial plateau fracture is the most common fracture around the knee. The incidence of tibial plateau fracture is approximately 13.3 per 100,000 individuals worldwide. Tibial plateau fracture showed bimodal distribution among women and a unimodal distribution among men. Men had an increasing incidence of fractures until 50 to 60 years of age, followed by a decline in incidence. Women showed a peak incidence between 20 and 30 years of age. The most common classification systems for tibial plateau fracture include Schatzker, Hohl and Moore, Luo’s three column concept and AO/OTA classification. The most common cause of tibial plateau fracture is trauma in form of motor vehicle accident and sports injury. Computed tomography (CT) is the gold standard test for the diagnosis of tibial plateau fracture. The non operative management is in the form of above knee cast or hinge knee brace for nondisplaced stable split fractures, fractures in elderly or patients with osteoporosis and minimally displaced or depressed fractures. Surgery is the mainstay of treatment for tibial plateau fractures.

In 1825, Sir Astley Cooper first described fractures of the proximal tibia and recommended treatment by re-alignment, splintage and early passive motion. In 1939, the first classification system was proposed by Marchant. In 1973, Rasmussen introduced open reduction and internal fixation (ORIF) of tibial condylar fractures. In 1979, Schatzker described his classification which is still commonly used today. In 1987, AO/OTA came up with its own classification for tibial plateau fracture.

There are multiple classifications available for tibial plateau fracture. The most common classification systems for tibial plateau fracture include Schatzker, Hohl and Moore, Luo’s three column concept and AO/OTA classification.

The pattern of fracture and degree of comminution are the resultant of several factors or variables such as the nature of injury, the bone quality, the age and weight of the patient, the energy involved, and the position of the knee and leg at the time of impact. Various combinations of these variables lead to a variety of different fracture patterns.

The most common cause of tibial plateau fracture is trauma in form of motor vehicle accident and sports injury.

Tibial plateau fracture must be differentiated from other causes of acute knee pain, restriction of movements, and deformity such as patella fracture, patella dislocation, knee dislocation, ligamentous injury such as anterior cruciate ligament, posterior cruciate ligament, collateral ligaments and meniscal injury

The incidence of tibial plateau fracture is approximately 13.3 per 100,000 individuals worldwide. Tibial plateau fracture showed bimodal distribution among women and a unimodal distribution among men. Men had an increasing incidence of fractures until 50 to 60 years of age, followed by a decline in incidence. Women showed a peak incidence between 20 and 30 years of age. The median age at diagnosis is 57.7 years for women and 46.8 years for men. There is no racial predilection to tibial plateau fracture. Men are more commonly affected by tibial plateau fracture than women. Surgical management for tibial plateau fracture is done 92% of the cases.

Common risk factors in the development of tibial plateau fracture include age, female gender, and health conditions.

The risk of tibial plateau fracture due to osteoporosis is threatening, affecting one out of two postmenopausal women and one out of five men older than 50 years. The 10-year risk for osteoporosis-related tibial plateau fracture in a 65-year-old white woman with no other risk factor is 9.3%. According to the guidelines of USPSTF, all women ≥ 65 years old along with women < 65 years old with a high risk of fracture are the target of screening for osteoporosis, but there is not any recommendation to screen men for the disease. Dual energy x-ray absorptiometry (DXA) of both hip and lumbar spine bones and quantitative ultrasonography of the calcaneus are two major methods suggested for screening osteoporosis.

If left untreated, majority of patients with tibial plateau fracture may progress to develop malunion and loss of range of motion of the knee. Common complications of tibial plateau fracture include knee stiffness, malunion, nerve injuries, and post traumatic arthritis. Prognosis is generally good, with most patients can resume their previous level of activity, including competitive sports.

Computed tomography (CT) is the gold standard test for the diagnosis of tibial plateau fracture. Computed tomography (CT) with two-dimensional reconstruction in the sagittal and coronal planes provides more detailed information than radiographs. CT is important to identify articular depression and comminution. CT also helps in fracture fragment orientation and surgical planning.

A positive history of pain, deformity, and restricted knee movements is suggestive of tibial plateau fracture.

Patients with tibial plateau fracture usually appears well. Physical examination of patients with tibial plateau fracture is usually remarkable for swelling, tenderness, bruises, ecchymosis, deformity and restricted range of motion of the leg.

There is a limited role for laboratory tests in the diagnosis of tibial plateau fracture; however, elderly women may have some abnormal laboratory findings suggestive of osteoporosis.

There are no ECG findings associated with tibial plateau fracture.

Radiographic imaging is important in diagnosis, classification, treatment and follow-up assessment of tibial plateau fracture. The routine minimal evaluation for tibial plateau fracture must include a antero-posterior (AP) view, oblique and lateral view. The radiological findings include abnormal joint alignment, depressed articular fragments and coronal split fractures.

There are no echocardiography/ultrasound findings associated with tibial plateau fracture.

Computed tomography (CT) with two-dimensional reconstruction in the sagittal and coronal planes provides more detailed information than radiographs. CT is important to identify articular depression and comminution. CT also helps in fracture fragment orientation and surgical planning.

Magnetic resonance imaging (MRI) helps in identifying associated meniscal, collateral, and cruciate ligamentous injury.

There are no other imaging findings associated with tibial plateau fracture.

There are no other diagnostic studies associated with tibial plateau fracture.

The non operative management is in the form of above knee cast or hinge knee brace for nondisplaced stable split fractures, fractures in elderly or patients with osteoporosis and minimally displaced or depressed fractures.

There are no recommended therapeutic interventions for the management of tibial plateau fracture.

Surgery is the mainstay of treatment for tibial plateau fractures. Fractures presenting with vascular injury as well as fracture dislocations should be managed emergently. The principles of definitive fixation for tibial plateau fractures include restoration of articular surface and mechanical axis alignment. The fracture fixation depends on fracture pattern. Approach for the fracture depends on fracture pattern and type of implant preferred by the surgeon. The implants commonly used include percutaneous cancellous and raft screws, locking plate, anti-glide plate, and external fixators including Ilizarov ring fixator.

There are no established measures for the primary prevention of tibial plateau fracture. Healthy diet and regular exercises like running and weight lifting help decrease the chances of fracture.

Effective measures for the secondary prevention of tibial plateau fracture include early detection and management of osteoporosis.

Template:WikiDoc Sources

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

In 1825, Sir Astley Cooper first described fractures of the proximal tibia and recommended treatment by re-alignment, splintage and early passive motion. In 1939, the first classification system was proposed by Marchant. In 1973, Rasmussen introduced open reduction and internal fixation (ORIF) of tibial condylar fractures. In 1979, Schatzker described his classification which is still commonly used today. In 1987, AO/OTA came up with its own classification for tibial plateau fracture.

• In 1825, Sir Astley Cooper first described fractures of the proximal tibia.^[1]

• In 1825, Sir Astley Cooper recommended treatment by re-alignment, splintage and early passive motion.^[1]
• In 1850’s, Anger treated most minimally displaced fractures with early knee traction mobilization.^[1]
• In 1939, the first classification system was proposed by Marchant.^[2]
• The 1960, Duparc and Ficat gave a classification which is commonly used is used in France.^[3]
• In 1972, Sarmiento popularized functional cast bracing of most tibial condylar fractures.^[4]
• In 1973, Rasmussen introduced open reduction and internal fixation (ORIF) of tibial condylar fractures.^[5]
• In 1979, Schatzker described his classification which is still commonly used today.^[6]
• In 1987, AO/OTA came up with its own classification.^[7]

Template:WH Template:WS

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

There are multiple classifications available for tibial plateau fracture. The most common classification systems for tibial plateau fracture include Schatzker, Hohl and Moore, Luo’s three column concept and AO classification.

There are multiple classifications available for tibial plateau fracture. The most common classification systems for tibial plateau fracture include Schatzker, Hohl and Moore, Luo’s three column concept and AO/OTA classification.^[1][2]

• Schatzker classification is the most commonly used classification for tibial plateau fracture.^[3]

Schatzker Classification
Type I	Lateral split fracture
Type II	Lateral Split-depressed fracture
Type III	Lateral Pure depression fracture
Type IV	Medial plateau fracture
Type V	Bicondylar fracture
Type VI	Metaphyseal-diaphyseal dissociation

• Hohl and Moore classification of tibial plateau fracture is useful for fracture dislocation, fracture patterns that cannot be classified by Schatzker classification and fractures associated with knee instability.^[4]

Hohl and Moore Classification
Type I	Coronal split fracture
Type II	Entire condylar fracture
Type III	Rim avulsion fracture of lateral plateau
Type IV	Rim compression fracture
Type V	Four-part fracture

• Luo’s classified tibial plateau fracture based on computed tomography ‘‘three column fixation’’ concept which aided in column-specific fixation technique.^[5]

Luo’s Three Column Classification
Zero-column fracture	Pure articular depression
1 Column fracture	Lateral column fracture
2 Column fracture	Lateral and posterior column fracture
3 Column fracture	Bicondylar fracture dividing into three fragments

• AO/ASIF classification is also a widely accepted classification.^[6]
• Proximal tibia is given the number 41 based on the classification.
• It is further subdivided as:

OTA System
A	Extra-articular fractures
	A1	Avulsion
	A2	Metaphyseal simple
	A3	Metaphyseal multifragmentary
B	Partial articular fractures
	B1	Pure split
	B2	Pure depression
	B3	Split depression
C	Complete articular fractures
	C1	Articular simple + metaphyseal simple
	C2	Articular simple, metaphyseal multifragmentary
	C3	Articular multifragmentary

Template:WH Template:WS

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

The pattern of fracture and degree of comminution are the resultant of several factors or variables such as the nature of injury, the bone quality, the age and weight of the patient, the energy involved, and the position of the knee and leg at the time of impact. Various combinations of these variables lead to a variety of different fracture patterns.

• The fracture pattern and severity of comminution depends on multiple factors including:^[1]
  • Nature of the fall
  • Bone quality
  • Age of the patient
  • Weight of the patient
  • Energy involved
  • Position of the knee and leg at the time of impact
• Decrease in bone mass density involves following process:^[2]
  • Autophagy is the mechanism through which osteocytes evade oxidative stress.
  • The capability of autophagy in cells decreases as they age, a major factor of aging.
  • As osteocytes grow, viability of cells decrease thereby decreasing the bone mass density.

• Majority of the weight in the lower leg is transmitted through tibia.^[3][4]
• The tibial plateau is the proximal portion of the tibia and forms the part of the knee joint.
• The stronger of the two articular surfaces is the medial tibial condyle whereas the lateral tibial condyle is a weaker portion of the joint.
• The medial from the lateral tibial condyle are separated by the intercondylar eminence which serves as the attachment for the anterior cruciate ligament (ACL).

Medial Condyle

• The medial condyle is larger than the lateral condyle.
• The articular surface of medial condyle is oval and it is long axis is anteroposterior.
• The central part of the medial condylar surface is slightly concave.
• The peripheral part is flat and separated from femoral condyle by the medial meniscus.

Lateral Condyle

• The lateral condyle overhangs the shaft of tibia.
• The articular surface is nearly circular.
• The central part is slightly concave and comes in direct contact with femoral condyle.
• The peripheral part is flat and separated from femur by the lateral meniscus.

• Proximal tibial injuries can occur due to direct trauma or indirect mechanisms such as axial compression.^[5]
• The causes of most tibial plateau fractures are a valgus stress associated with an axial load.
• Most tibial plateau fractures result from motor vehicle-related injuries followed by sports-associated injuries.
• The bumper of a car striking the lateral plateau during this vehicle–pedestrian-related injury causes a valgus mechanism of injury.
• Motor vehicle injuries are high energy and often result in splitting types of fractures as well as direct injury to the surrounding soft tissues.
• Low-energy forces can cause a tibial plateau fracture usually in older patients with poor bone quality due to rotational forces.
• Such injuries are primarily seen in women >50 years with osteoporosis resulting in a depressed pattern plateau fracture.

Template:WH Template:WS

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

The most common cause of tibial plateau fracture is trauma in form of motor vehicle accident and sports injury.

The most common cause of tibial plateau fracture is trauma in form of motor vehicle accident and sports injury.^{[1][2][3][4][5]}

• There are no life-threatening causes of tibial plateau fracture, however complications resulting from tibial plateau fracture is common.

Common causes of tibial plateau fracture may include:

• Trauma (motor vehicle accident and sports injury)

Less common causes of tibial plateau fracture include conditions that predisposes to fracture:

• Osteoporosis
• Osteopenia

Cardiovascular	No underlying causes
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal/Orthopedic	Osteoporosis and osteopenia.
Neurologic	No underlying causes
Nutritional/Metabolic	Osteoporosis and osteopenia.
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	No underlying causes
Rheumatology/Immunology/Allergy	No underlying causes
Sexual	No underlying causes
Trauma	Fall on an outstretched hand.
Urologic	No underlying causes
Miscellaneous	No underlying causes

List the causes of the disease in alphabetical order:

Template:WH Template:WS

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

Tibial plateau fracture must be differentiated from other causes of acute knee pain, restriction of movements, and deformity such as patella fracture, patella dislocation, knee dislocation, ligamentous injury such as anterior cruciate ligament, posterior cruciate ligament, collateral ligaments and meniscal injury

• Tibial plateau fracture must be differentiated from other causes of acute knee pain, restriction of movements, and deformity such as patella fracture, patella dislocation, knee dislocation, ligamentous injury such as anterior cruciate ligament, posterior cruciate ligament, collateral ligaments and meniscal injury.^{[1][2][3][4][5]}

Diseases	Clinical manifestations						Para-clinical findings			Gold standard	Additional findings
	Symptoms			Physical examination
							Imaging
	Pain	Restriction of Movements	Deformity	Tenderness	Integrity of extensor mechanism	Distal Pulses	X-ray	CT scan	MRI
Tibial plateau fracture	+	+	+/-	+	+	+/-	Fracture fragment displacement Fracture fragment angulation	Accurate diagnosis of fracture pattern ans aids in classification. Useful for preoperative surgical planning for patients with complex, multifragmentary fractures.	Useful in diagnosing occult fractures, ligamentous and soft tissue injuries	CT
Segond Fracture	+	+	–	+	+	+	Evidence of fracture on radiographs is usually seen	Evidence of fracture on CT scan is usually seen.	Soft tissue swelling and tear of the anterior cruciate ligament (ACL) accompanying the fracture is seen	MRI	It is pathgnomic of ACL tear
Patella Fracture	+	+	+	+	–	+	Fracture fragment displacement Fracture fragment angulation	CT confirms the x-ray finding.	Swelling and tear of the patellar tendon and the retinaculum may be seen Also helps to identify osteochondral fragments	X-ray	Inability to do straight leg raising test.
Tibial tuberosity avulsion fracture	+	+	+	+	–	+	Tuberosity avulsion and displacement is seen	CT confirms the x-ray finding	Helps to identify accompanying patellar tendon injury	X-ray	Inability to do straight leg raising test.
Patellar dislocation	+	+	+	+	+/-	+	Disclocated patella Subluxated patella Associated fractures	CT confirms x-ray findings	Identifies damage to medial patellofemoral ligament. Identifies damage to retinacular ligament and orientation of the surrounding muscles	MRI	Apprehension Test positive
Knee Dislocation	+	+	+	+	+/-	+/-	Type of knee dislocation Associated fractures	CT confirms the x-ray findings and shows any osteochondral injury	MRI shows damage to internal structures such as muscles, ligaments and neurovascular bundle.	MRI	Angiography of the lower limb is mandatory to check blood flow to the lower limb and decrease the chances of vascular insult
Diseases	Pain	Restriction of Movements	Deformity	Tenderness	Integrity of extensor mechanism	Distal Pulses	X-ray	CT scan	MRI	Gold standard	Additional findings
Meniscus Injury	+	+/-	–	+/-	+	+	Normal	Normal	It helps identify the type of tear and classify the tear. It also aids in management plan for meniscal injury.	MRI	McMurray’s est positive for meniscal injury
Ligament Injuries (ACL, PCL, MCL, LCL)	+	+/-	–	+	+	+	Usually Normal It may show associated avulsion fracture	Normal	It helps to identify partial or complete tear It also aids in distinguishing acute versus chronic tears It may show signs of early degeneration and cartilage wear due to ligament injury	MRI	Lachman test and Anterior Drawer test positive in Anterior cruciate ligament tear (ACL) Posterior drawer test and Dial test positive for posterior cruciate ligament (PCL) Valgus stress test is positive for Medial Collateral Ligament (MCL) Varus stress test is positive for Lateral Collateral Ligament (LCL)
Quadriceps Tendon Rupture	+	+	+	+	–	+	Usually Normal It may show associated avulsion fracture	Normal	It shows degree of tear It also aids in surgical planning	MRI	Defect present superior to superior pole of patella
Osgood – Schlatter Disease	+	+	–	+	+	+	Fracture of tibial tuberosity apophysis is seen	CT confirms x-ray findings	Swelling and effusion of the joint may be seen	X-ray	Adolescents are commonly affected by the disease.
Peripheral Vascular Injuries	+	–	–	+	+	–	Normal	Normal	Normal	Doppler ultrasound	Doppler ultrasound and angiography of the lower limb confirms the disease
Maisonneuve Fracture	+	+	+	+	+	+	Fracture fragment displacement Fracture fragment angulation	CT confirms x-ray findings	Useful in diagnosing occult fractures, ligamentous and soft tissue injuries	X-ray	Foot drop may be present in few patients Electromyography and Nerve conduction studies done to check for any damage to commom peroneal nerve

Template:WH Template:WS

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

The incidence of tibial plateau fracture is approximately 13.3 per 100,000 individuals worldwide. Tibial plateau fracture showed bimodal distribution among women and a unimodal distribution among men. Men had an increasing incidence of fractures until 50 to 60 years of age, followed by a decline in incidence. Women showed a peak incidence between 20 and 30 years of age. The median age at diagnosis is 57.7 years for women and 46.8 years for men. There is no racial predilection to tibial plateau fracture. Men are more commonly affected by tibial plateau fracture than women. Surgical management for tibial plateau fracture is done 92% of the cases.

• The incidence of tibial plateau fracture is approximately 13.3 per 100,000 individuals worldwide.^[1]

• Patients of all age groups may develop tibial plateau fracture.^[2][3]
• Tibial plateau fracture showed bimodal distribution among women and a unimodal distribution among men.
• Men had an increasing incidence of fractures until 50 to 60 years of age, followed by a decline in incidence.
• Women showed a peak incidence between 20 and 30 years of age.
• After the age of 40 years, they had an increase in incidence throughout life compared with men.
• Tibial plateau fractures are most common between the ages of 30 and 60 years.
• The median age at diagnosis is 57.7 years for women and 46.8 years for men.

• There is no racial predilection to tibial plateau fracture.^[4]

• Men are more commonly affected by tibial plateau fracture than women.^[3][5]
• The Male to female ratio is approximately 2.4 to 1.

• Conservative management for tibial plateau fracture is done 8% of the cases.^[6]
• Surgical management for tibial plateau fracture is done 92% of the cases.

Template:WH Template:WS

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

Common risk factors in the development of tibial plateau fracture include age, female gender, and health conditions.

• Many tibial plateau fracture commonly occur in healthy bones if the trauma is severe enough such as a car accident or sports injury. They can happen even in people over 60 are due to osteoporosis if the fall was relatively minor such as a fall from a standing position.^{[1][2][3][4][5]}

• The incidence of distal radius fracture has a bimodal distribution during the life span.
• The incidence is high in the young adulthood and increases again in older adults.

• Gender distribution curves for tibial plateau fracture incidence in the young to middle adulthood indicate that men aged 19-49 years have a higher risk than women of the same age.
• Beyond that age, the rate of tibial plateau fracture increases markedly such that women older than 50 years have a 15% lifetime risk, whereas the incidence in men remains low until they reach the age of 80 years.

• Health conditions that predispose to increase risk of tibial plateau fracture include:^[6]
  • Osteoporosis
  • chronic stroke
  • Diabetes
  • Rheumatoid arthritis
  • Chronic kidney disease

Template:WH Template:WS

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

The risk of tibial plateau fracture due to osteoporosis is threatening, affecting one out of two postmenopausal women and one out of five men older than 50 years. The 10-year risk for osteoporosis-related tibial plateau fracture in a 65-year-old white woman with no other risk factor is 9.3%. According to the guidelines of USPSTF, all women ≥ 65 years old along with women < 65 years old with a high risk of fracture are the target of screening for osteoporosis, but there is not any recommendation to screen men for the disease. Dual energy x-ray absorptiometry (DXA) of both hip and lumbar spine bones and quantitative ultrasonography of the calcaneus are two major methods suggested for screening osteoporosis.

The risk of tibial plateau fracture due to osteoporosis is threatening, affecting one out of two postmenopausal women and one out of five men older than 50 years. Osteoporosis usually affects the Caucasian population. The rate of osteoporosis is higher in the elderly. The 10-year risk for osteoporosis-related tibial plateau fracture in a 65-year-old white woman with no other risk factor is 9.3%. .

The US Preventive Services Task Force (USPSTF) divides the population into three groups, categorizing them on the basis of their need to be screened for osteoporosis. They include:

• Women of age ≥ 65 year, without any fracture history or pathological reason for osteoporosis
• Women of age <65 years, with 10-year fracture risk of not less than a 65-year-old white woman (who has not any other risk factor)
• Men with no history of osteoporosis

According to the guidelines of USPSTF, the first two groups (women) are the target of screening for osteoporosis. There is no recommendation to screen the third group (men) for the disease.^[1]

The USPSTF recommendations from 2002 included:

• All women of 65 and older should be screened by bone marrow densitometry.^[2]
• Women aged 60-64 years old, who are at increased risk of fracture. The most significant risk factor for indicating an increased probability of having osteoporosis is low body weight (< 70 kg).
• Clinical prediction rules are available to guide the selection of women for screening.
• The Osteoporosis Risk Assessment Instrument (ORAI) is the most sensitive strategy.^[3]
• Regarding the screening process for men, a cost-analysis study suggests that screening may be “cost-effective for men with a self-reported prior fracture beginning at age 65 years, and for men 80 years and older with no prior fracture“.^[4]

There are two major methods, that are suggested to be used for screening for osteoporosis:

• Dual energy x-ray absorptiometry (DXA) of both hip and lumbar spine bones
• Quantitative ultrasonography of the calcaneus

Advantages of ultrasonography over DXA scan:

Although quantitative ultrasonography has numerous advantages when compared to DXA but still current diagnostic and treatment criteria rely on DXA of the hip and lumbar spine. The advantages include:

• Lower cost
• More portable
• Lower ionizing radiation exposure

After an initial screening is done for bone mineral density (BMD), optimal intervals to repeat the tests include:

• 15 years for women with normal bone density or mild osteopenia: T-score of greater than −1.50
• 5 years for women with moderate osteopenia: T-score of −1.50 to −1.99
• 1 year for women with advanced osteopenia: T-score of −2.00 to −2.49^[5]

Template:WH Template:WS

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

If left untreated, majority of patients with tibial plateau fracture may progress to develop malunion and loss of range of motion of the knee. Common complications of tibial plateau fracture include knee stiffness, malunion, nerve injuries, and post traumatic arthritis. Prognosis is generally good, with most patients can resume their previous level of activity, including competitive sports.

• If left untreated, majority of patients with tibial plateau fracture may progress to develop malunion and loss of range of motion of the knee and early post traumatic arthritis.^[1][2]

• Complications can be divided into early and late.^[3][4][5][6]
• Most early complications can be viewed as biologic failures, whereas late complications are often associated with problems.

Early Complications

Early complications include the following:

• Compartment syndrome
• Vascular injuries
• Loss of reduction
• Swelling and wound-healing problems
• Infections
• Deep vein thrombosis
• Nerve injuries

Late Complications

Late complications include the following:

• Knee stiffness
• Knee instability
• Angular deformities
• Late collapse
• Nonunion
• Implant breakage
• Malunion
• Post traumatic arthritis

• Prognosis is generally good, with most patients can resume their previous level of activity, including competitive sports.^[7][8]
• Most patients will likely lose a few degrees of final flexion and extension, and possibly rotation as well; however, these limitations generally do not prevent full function.
• Some patients are unable to resume their prior level of functioning.
• All treatment approaches have a percentage of poor results, with decreased flexion and extension, prominent implants, ligamentous instability, and degenerative joint disease.

Template:WH Template:WS