Tibial Plateau Fractures

Tibial plateau fractures come in many varieties, but in most instances, present management challenges on many levels. The majority of tibial plateau fractures are treated surgically, given their intraarticular or periarticular nature and their typical magnitude of displacement and instability. The first treatment dilemma is the decision regarding when to operate. Not too long ago, early open treatment of high-energy bicondylar tibial fractures was clearly recognized as a high-risk situation. Focus was appropriately shifted to the soft tissue component of these injuries. In this issue, Dr. Borrelli discusses some pertinent anatomical features of the proximal tibia, as well as indications and techniques for provisional spanning external fixation. Along similar lines, but focusing more globally on the prevention and treatment of complications associated with tibial plateau fractures, Drs. Choo and Morshed provide an extremely insightful and comprehensive overview of complications.

Just as fixation strategies and implants have evolved over the last decade, so have surgical approaches to the proximal tibia. Depending on the specific fracture pattern, one or several of half a dozen surgical approaches may be appropriate. Drs. Kandemir and Maclean present step-by-step descriptions of common approaches to the tibial plateau, including posterolateral, posteromedial, and direct posterior approaches. The descriptive text is accompanied by many illustrative photographs.

Despite the frequent focus on specific implants, it must be remembered that the reduction is arguably the most important aspect of surgical treatment. As such, Mauffrey et al present a novel cutting-edge reduction technique using inflatable balloon tamps that is currently a hot topic. Excellent technique descriptions and examples are included, as well as the specific ideal indications for this technique.

Finally, given the recent descriptive, biomechanical, and clinical literature revolving around the medial component of bicondylar tibial plateau fractures, Dr. Cherney and myself have dedicated a manuscript to this topic. Several common variations of the medial fracture component are discussed, as well ideal treatments for different patterns.

This issue of the Journal of Knee Surgery features some of the world's experts in tibial plateau fracture treatment. These authors have devoted their careers to studying the natural history of these fractures and pioneering new techniques and surgical approaches to maximize patient outcomes. We hope you enjoy this issue, and find these papers useful for your practice.