Anterior tibial plateau fracture: An often missed injury

Abstract

Background

In most classifcations of tibial plateau fractures, including one used most widely-Schatzker classifcation, fractures are described as a combination of medial and lateral condyle, primarily in the sagittal plane. Coronal component of these fractures, affecting the posterior tibial condyle is now well recognized. What is not described is anterior coronal component of the fracture, what we are calling “anterior tibial condyle fracture”. These fractures are often missed on routine antero-posterior and lateral knee X-rays due to an overlap between the fracture and the normal bone.

Materials and Methods

Eight cases of anterior tibial condyle fractures with posterior subluxation of the tibia, six of which were missed by the initial surgeon and two referred to us early, are described. Two of the six late cases and both the early ones were operated. Reconstruction of the anterior condyle and posterior cruciate ligament reconstruction was done. Primary outcome measures such as union of the fracture, residual fexion deformity, range of motion and stability were studied at the end of 6 months.

Results

All operated fractures united. There was no posterior sag in any. In those presenting late and were operated, the fexion deformity got corrected in all (average from 15° to 0°) and mean fexion achieved was 100° (range: 80-120°). In those presenting early and were operated, there was no fexion deformity at 6 months and a mean fexion achieved was 115° (range: 100-130°). None of the operated patients had instability.

Conclusion

This article attempts to highlight that this injury is often missed. They should be suspected, diagnosed early and treated by reconstruction of anterior condyle, posterior cruciate ligament reconstruction.