Tibial Plateau Fracture Following Low Energy Fall in the Rocky Mountains

Abstract

Tibial plateau fractures are debilitating injuries. They can occur
in younger individuals who sustain a high energy trauma or, with
increasing age, lesser degrees of trauma and underlying bone pathology such as osteoporosis, metabolic bone disease, and malignancy.1
Outside these cases, tibial plateau fractures are relatively uncommon.
However, these fractures can occur in healthy patients who have sustained direct trauma to the knee.
Fractures of the tibial plateau often are classified according to the
Schatzker or AO classification systems.2,3 These systems evaluate the
involvement of both the medial and lateral plateaus, degree of comminution, extension into the joint, and displacement (both articular
surfaces and the relationship of the diaphysis to the metaphysis).
Most tibial plateau fractures occur in the lateral aspect of the tibial
plateau.1
The increased frequency of lateral fractures is due to the
medial tibial plateau being able to resist higher weight-bearing load
due to the presence of more cancellous bone. More importantly, the
lateral plateau has more articular surface exposed during extension
compared to the medial plateau, which increases likelihood of injury.4
The standard of care for most displaced tibial plateau fractures
is surgical management with open reduction and internal fixation
(ORIF).5
Conservative management, such as leg bracing, is an option
for fractures that are nondisplaced or in patients too fragile for surgical intervention. In the senior population, a total knee arthroplasty
(TKA) is a less common option. Tibial plateau fractures, particularly
medial tibial plateau fractures, caused by direct trauma in the elderly,
non-osteoporotic population are uncommon.
We present the case of an active male without overt risk for severe
fracture (10-year fracture risk of 10% via FRAX score) who was
working to repair a trail in the Rocky Mountains. While other injuries
were more likely given the mechanism of injury and patient risk, this
case highlighted the importance of considering tibial plateau fracture,
even in atypical settings without significant risk. Improved awareness
of this mechanism of injury will lead to more accurate diagnosis and
greater post-injury management.