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Medial Tibial Plateua Fractures

- See:
      - Bicondylar Fractures and Type V Fractures:
      - Split Fractures:
      - Surgical Approach: Medial Compartment:
      - Type IV Fractures:
      - Total Depression Fracture:
- X-ray:
    - if knee is unstable (greater > 5 deg instability), stress x-rays are made todetermine whether the instability is secondary to movement 
          at frx site
          or to ligament injury;
          - when instability is due to a fracture movement, a cast brace is used to stabilize the leg;
- Indications for Treatment:
    - medial condyle frxs although displaced or depressed only a few mm, need open reduction and internal fixation to prevent frx migration;
          - this is esp true w/ intact fibula;
    - lateral condyle frx of < 5 mm displacement are treated w/ traction for a few days, then cast brace until healed;
- Operative Treatment:
    - PreOp Planning
    - beacuse Medial Plateua fractures tend to be more unstable, consider percutaneous pin fixation or screw fixation, followed by cast brace;
         - varus malunion resulting from loss of position of medial  plateau fracture promotes early osteoarthritis;
- Post Operative Care and Compications:
    - minimally displaced fractures of lateral plateau are stable & require little external support during healing;
    - medial plateau frxs, however, whether stable or unstable, have tendency to displace, esp w/ intact fibula;
         - varus deformity gradually develops after non operative treatment;
         - varus malunion from resulting from loss of position of medial plateau frx promotes early development of traumatic arthritis;
    - these frxs may lose position gradually during non op treatment & return to displacement that was present during traumatic incident;
    - this is especially likely to occur in oblique frx that extend from region of intercondylar notch to medial or lateral tibial cortex;
    - Radiographs should be obtained periodically during first few wks after injury to assure that reduction is being maintained

Posteromedial tibial plateau fractures. Operative treatment by posterior approach.