A decade-long prospective series of 988 tibial plateau fractures from LA County-USC, with 320 isolated fractures followed 1 to 10 years. It defines the injury, sets indications for traction versus surgery, and correlates residual plateau depression with long-term knee function.
When you evaluate a plateau fracture, the decision to operate hinges on one exam finding: instability to valgus-varus stress with the knee in full extension. This paper grounds that rule in anatomy. Lateral cartilage is about 4 mm thick and medial about 2.5 mm, which is why the depression threshold for surgery is lower medially.
The geometric pearl is worth memorizing: roughly 2 degrees of malalignment per 1 mm of average depression. That is why residual depression predicts worse function and why anatomic restoration matters.
The cautionary lesson is infection. It was the leading surgical complication and cut return-to-activity to 32%, which is why the authors moved to routine perioperative antibiotics and a single plate for bicondylar fractures.
Remember the traction contraindications: medial plateau fractures (Buck's traction adds varus) and depressed type II/III fractures (traction cannot elevate the central fragment).
A decade-long prospective series of 988 tibial plateau fractures from LA County-USC, with 320 isolated fractures followed 1 to 10 years. It defines the injury, sets indications for traction versus surgery, and correlates residual plateau depression with long-term knee function.
When you evaluate a plateau fracture, the decision to operate hinges on one exam finding: instability to valgus-varus stress with the knee in full extension. This paper grounds that rule in anatomy. Lateral cartilage is about 4 mm thick and medial about 2.5 mm, which is why the depression threshold for surgery is lower medially.
The geometric pearl is worth memorizing: roughly 2 degrees of malalignment per 1 mm of average depression. That is why residual depression predicts worse function and why anatomic restoration matters.
The cautionary lesson is infection. It was the leading surgical complication and cut return-to-activity to 32%, which is why the authors moved to routine perioperative antibiotics and a single plate for bicondylar fractures.
Remember the traction contraindications: medial plateau fractures (Buck's traction adds varus) and depressed type II/III fractures (traction cannot elevate the central fragment).