Evolution of Technology

Proximal Tibial Locking Plate

Fixation of the tibial plateau is usually performed using plates and screws. Due to the poor quality of bone in the tibial plateau, however, normal plates and screws have been insufficient for fixation in some patients, and special locked plates are usually used.

Locked plating was introduced in the early 19th century and popularized in the 1960s. Locked plates describe plates in which the screw has threads around the head which thread into the plate. This increases the stiffness of the construct, which helps to hold softer bone in place. Locked plating around the upper end, or proximal end, of the tibia continues to evolve to provide strong, stable fixation while striving to remain small enough so that the plates don’t bother patients.

In modern plating systems there are specialized plates that sit on specific parts of the bone to provide fixation in those areas. These plates are usually made of titanium, but can be made of stainless steel for stiffer fixation. Large screws are usually used as close to the joint as possible to act as large rafters to keep the joint surface fixed in place, while screws farther down the plate fix the actual plate to the bone.

Evolution of Procedure

Tibial Plateau Repair

Fixing breaks in the tibial plateau is usually performed with plates and screws and is performed through incisions through the medial or lateral skin over the knee. Care is taken during the surgery to avoid the arteries and nerves behind the knee and to avoid damaging any uninjured structures in the knee itself.

The ultimate goal of the surgery is to restore the joint surface of the tibial plateau to as normal as possible and to fix all of the broken pieces of the plateau back to the rest of the tibia. Patients are usually placed in a knee brace and aren’t allowed to place weight on their leg until several weeks after surgery.

Evolution of Diagnosis

Tibial Plateau Fracture

The upper end of the shin bone (tibia) is known as the plateau. It is relatively flat, and makes up the lower end of the knee joint. Injuries to the tibial plateau are usually caused by a large amount of weight being forced through the leg such as falls and car crashes. As such, these injuries can vary widely in their severity.

For some of these injuries, patients will be placed into a splint or knee immobilizer and surgery scheduled for several days or weeks from the time of injury to allow for swelling to decrease. The actual break in the bone of the tibial plateau is usually defined as being medial or lateral, referring to which side of the plateau that the break is in. Symptoms of this injury typically include a large amount of swelling and pain around the knee.