This retrospective study asks whether lateral tibial plateau compression fractures should be operated on based on radiographic depression or on clinical joint stability. Forty elderly patients with central or posterior compression and intact extension stability were treated non-operatively and followed for an average of 6 years.
When you see a lateral tibial plateau compression fracture, examine stability with the knee in full extension before you commit to surgery based on the X-ray alone.
The classic teaching that more than 5 mm of depression requires operation is what this paper challenges. Central and posterior compressions leave an intact peripheral rim that supports the femoral condyle in extension, so the knee stays stable even with 20 mm of depression.
Two practical pitfalls matter here. A tense hemarthrosis or hamstring spasm from pain can block full extension and mimic instability, so aspirate the joint and consider anesthesia before declaring the knee unstable.
Remember the patient context. This works for elderly patients whose gait keeps flexion under 20 degrees. A young athlete needs a stable flexed knee, so anatomic reconstruction is still appropriate even when the extended knee is stable.
This retrospective study asks whether lateral tibial plateau compression fractures should be operated on based on radiographic depression or on clinical joint stability. Forty elderly patients with central or posterior compression and intact extension stability were treated non-operatively and followed for an average of 6 years.
When you see a lateral tibial plateau compression fracture, examine stability with the knee in full extension before you commit to surgery based on the X-ray alone.
The classic teaching that more than 5 mm of depression requires operation is what this paper challenges. Central and posterior compressions leave an intact peripheral rim that supports the femoral condyle in extension, so the knee stays stable even with 20 mm of depression.
Two practical pitfalls matter here. A tense hemarthrosis or hamstring spasm from pain can block full extension and mimic instability, so aspirate the joint and consider anesthesia before declaring the knee unstable.
Remember the patient context. This works for elderly patients whose gait keeps flexion under 20 degrees. A young athlete needs a stable flexed knee, so anatomic reconstruction is still appropriate even when the extended knee is stable.