Tibial Plateau Fracture With Use of Tibia Strut and Bone Filler in a 37-Year-Old Male: A Case Report.

ABSTRACT

Tibial plateau fractures (TPFs) are orthopedic challenges with multiple injury modalities and clinical presentations. TPFs are often classified using the Schatzker classification system, which can dictate management. In our case, a 37-year-old male presented at an orthopedic specialty hospital with right knee pain after a fall from a truck ramp. X-rays and CT imaging demonstrated a comminuted bicondylar TPF in the emergency room with metaphyseal dissociation. The patient was placed in a knee immobilizer, made non-weight bearing, and scheduled for outpatient follow-up with a local orthopedic surgeon. The patient was lost to follow-up and referred to our clinic six months after the fall with the chief complaint of inability to ambulate with severe pain and instability in the knee. X-rays demonstrated a malunion of the bicondylar tibial plateau with fracture deformities of the medial femoral condyle and lateral tibial plateau. The patient's deformity was corrected with a medial opening wedge proximal tibial osteotomy with a fibula strut allograft and filled with beta-tricalcium bone filler. At the first month follow-up, the patient's pain was well controlled, fragments and the knee were appropriately aligned, and no significant soft tissue or joint effusion was appreciated on imaging. After failing nonoperative treatment, this patient with comminuted bicondylar TPF has received definitive treatment with open reduction and internal fixation. Higher rates of unacceptable results from nonoperative treatment are in line with the Schatzker series, in which operative treatment resulted in more acceptable outcomes. Because the fracture in this patient is consistent with a Schatzker VI classification with intra-articular depression, the patient should have initially been treated with an external fixator and not been sent home in a knee immobilizer. This led to a malunion that necessitated corrective surgery. Therefore, correctly classifying fracture severity is important for selecting the best treatment course and minimizing complications.