Tibial plateau fractures: a study of associated soft tissue injuries

Tibial plateau fractures can occur concomitant with injuries to the collateral and cruciate ligaments, menisci, and surrounding nerves and arteries. The purpose of this article is to record the frequency of these soft tissue injuries with tibial plateau fractures. Patients with plateau fractures were entered into a prospective protocol consisting of radiographic evaluation, Schatzker classification, pre- and postfixation stress testing, and diagnostic arthroscopy. Thirty tibial plateau fractures were evaluated in this study. There was a 56% (17 of 30) frequency of associated soft tissue injuries in this series of tibial plateau fractures. The medial collateral ligaments were injured in 20% (six of 30), the lateral collateral ligaments in 3% (one in 30), the menisci in 20% (six in 30), the peroneal nerve in 3% (one in 30), and the anterior cruciate ligaments in 10% (three in 30). Schatzker type IV and type II fracture patterns were associated with the highest frequency of soft tissue injuries. Medical collateral ligament injuries were most commonly associated with Schatzker type II fracture patterns. Menisci were most commonly injured with Schatzker type IV fracture patterns. Based on the findings, routine arthroscopy should be indicated in nondisplaced Schatzker type I fractures. Pre- and postfixation stress testing should be performed to diagnose collateral and cruciate ligament injuries.