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TIBIAL PLATEAU FRACTURES

Mechanism of injury

Fractures of the tibial plateau are caused by a varus or valgus force combined with axial loading (a pure valgus force is more likely to rupture the ligaments). This is sometimes the result of a car striking a pedestrian (hence the term 'bumper fracture’); more often it is due to a fall from a height in which the knee is forced into valgus or varus. The tibial condyle is crushed or split by the opposing femoral condyle, which remains intact.

Pathological anatomy

The fracture pattern and degree of displacement depend on the type and direction of force as well as the quality of the bone at the upper end of the tibia.  A useful classification is that of Schatzker (Fig. 30.17):

Type 1 – a vertical split of the lateral condyle 

This is a fracture through dense bone, usually in younger people. It may be virtually undisplaced, or the condylar fragment may be pushed inferiorly and tilted; the damaged lateral meniscus may be trapped in the crevice.

Type 2 – a vertical split of the lateral condyle combined with depression of an adjacent loadbearing part of the condyle 

The wedge fragment, which varies in size from a portion of the rim to a sizeable part of the lateral condyle, is displaced laterally; the joint is widened and, if the fracture is not reduced, may later develop a valgus deformity.

Type 3 – depression of the articular surface with an intact condylar rim 

Unlike type 2, the split to the edge of the lateau is absent. The depressed fragments may be wedged firmly into the subchondral bone. The joint is usually stable and may tolerate early movement.

Type 4 – fracture of the medial tibial condyle 

Two types of fracture are seen: (1) a depressed, crush fracture of osteoporotic bone in an elderly person (a low-energy lesion), and (2) a high-energy fracture resulting in a condylar split that runs obliquely from the intercondylar eminence to the medial cortex. The momentary varus angulation may be severe enough to cause a rupture of the lateral collateral ligament and a traction injury of the peroneal nerve. The severity of these injuries should not be underestimated.

Type 5 – fracture of both condyles 

Both condyles are split but there is a column of the metaphysis wedged in between that remains in continuity with the tibial shaft. 

Type 6 – combined condylar and subcondylar fractures 

This is a high-energy injury that may result in severe comminution. Unlike type 5 fractures, the tibial shaft is effectively disconnected from the tibial condyles.

---from 《Apley’s System of Orthopaedics and Fractures》

重點(diǎn)詞匯整理：

plateau/pl??to?/n. 高原；穩(wěn)定水平；托盤；平頂女帽vi. 達(dá)到平衡；達(dá)到穩(wěn)定時(shí)期

tibial plateau脛骨平臺(tái)

bumper fracture車撞骨折

bumper  /?b?mp?r/n. 保險(xiǎn)杠；滿杯；（板球）反彈球；新馬平地賽；廣告時(shí)段；大滿杯敬酒；（非正式）煙頭adj. 豐盛的；巨大的；首尾相接的v. 滿杯祝酒；干杯；裝滿

 It may be virtually undisplaced,可能沒(méi)有移位

the damaged lateral meniscus may be trapped in the crevice受損的外側(cè)半月板可能困在裂隙中

meniscus  /m??n?sk?s/n. [解剖] 半月板；彎月面；新月形物

 crevice /?krev?s/n. 裂縫；裂隙

 wedge fragment楔形骨塊

 wedge  /wed?/n. 楔子；楔形物；不和v. 楔入；擠進(jìn)；楔住

obliquely /??bli?kli/adv. 傾斜地；轉(zhuǎn)彎抹角地

intercondylar eminence髁間隆起

peroneal nerve腓總神經(jīng)

 /,per?'ni:?l/adj. 腓骨的；腓側(cè)的

有道翻譯（僅供參考，建議自己翻譯）：

脛骨平臺(tái)骨折

損傷機(jī)制

脛骨平臺(tái)骨折是由內(nèi)翻或外翻力和軸向載荷共同作用造成的（單純外翻力更容易使韌帶斷裂）。這有時(shí)是由于汽車撞到行人（因此稱為“保險(xiǎn)杠骨折”）；更常見(jiàn)的是由于從某個(gè)高度墜落，膝蓋被迫外翻或內(nèi)翻。脛骨髁被相對(duì)的股骨髁壓碎或撕裂，股骨髁保持完整。

病理解剖學(xué)

骨折類型和移位程度取決于力的類型和方向以及脛骨上端的骨質(zhì)量。一個(gè)有用的分類是Schatzker（圖30.17）：

1型-外側(cè)髁的垂直裂開(kāi)這是一種穿過(guò)致密骨的骨折，通常發(fā)生在年輕人身上。髁突可能幾乎沒(méi)有移位，或者髁突碎片可能被推到下方并傾斜；受損的外側(cè)半月板可能卡在縫隙中。

2型–外側(cè)髁的垂直分裂與相鄰承載部分髁狀突的凹陷相結(jié)合楔形碎片，其大小從邊緣的一部分到外側(cè)髁的相當(dāng)大的一部分不等，橫向移位；關(guān)節(jié)變寬，如果骨折沒(méi)有減少，以后可能會(huì)出現(xiàn)外翻畸形。

3型-關(guān)節(jié)面凹陷，髁突邊緣完整。與2型不同，髁突邊緣無(wú)裂口。凹陷的碎片可以牢固地楔入軟骨下骨。關(guān)節(jié)通常是穩(wěn)定的，可以承受早期運(yùn)動(dòng)。

4型-脛骨內(nèi)側(cè)髁骨折兩種類型的骨折：（1）老年人骨質(zhì)疏松性骨凹陷粉碎性骨折（低能量損傷），和（2）高能量骨折導(dǎo)致髁狀突從髁間隆起向內(nèi)側(cè)皮質(zhì)傾斜。瞬間內(nèi)翻角度可能嚴(yán)重到足以導(dǎo)致外側(cè)副韌帶斷裂和腓神經(jīng)牽拉損傷。這些傷害的嚴(yán)重程度不應(yīng)低估。

5型-雙髁骨折-雙髁分離，但中間有一根干骺端，與脛骨干保持連續(xù)性。

6型-髁突和髁下聯(lián)合骨折這是一種可能導(dǎo)致嚴(yán)重粉碎的高能損傷。與5型骨折不同，脛骨干與脛骨髁有效斷開(kāi)。