Generality
The tibial plateau is the particular smooth surface that characterizes the upper portion of the proximal end of the tibia.
It can be divided into a medial tibial plateau and a lateral tibial plateau; the tibial plateau is one of the fundamental constitutive elements of the knee joint; just think that, in a particular region, the anterior cruciate ligament of the knee, the posterior cruciate ligament and the two meniscuses are inserted.
If subjected to significant trauma, the tibial plateau may undergo a fracture.
Tibial plateau fractures are quite painful, are somewhat debilitating and, to heal, require several weeks of chalk and absolute rest.
Tibia Review
The tibia is the even bone which, together with the fibula, constitutes the skeleton of the leg ; the leg is the anatomical portion of each lower limb running from the knee to the ankle .
Belonging to the category of long bones (such as the femur, humerus, etc.), the tibia takes part in the formation of two important joints: the knee joint, above, and the ankle joint, below.
Like any long bone, the tibia can be divided into three main portions, known as: proximal end (or proximal epiphysis), body (or diaphysis) and distal end (or distal epiphysis).
The proximal end of the tibia is its upper portion, ie that which takes part in the knee joint and which lies below the femur (thigh bone); the body of the tibia is its central portion, ie that interposed between the proximal end and the distal end; finally, the distal end of the tibia is its lower portion, ie the one that forms the ankle joint and takes place above the bones of the foot (astragalus, calcaneus, etc.).
From the functional point of view, the tibia is important because:
- It supports the weight of the upper part of the body, lightening the load at the level of the foot;
- It allows locomotion, through the knee and ankle joints.
What is the Tibiale Plate?
The tibial plateau is the upper surface of the proximal end of the tibia; in other words, it is the portion of the tibia that looks towards the knee and, moving even higher, looking towards the femur.
The tibial plateau is also known as the "articular surface of the tibia", as, as will be seen in the chapter dedicated to its functions, it is among the protagonists of the knee joint.
Origin of the name
As can be easily understood, the tibial dish has this name, because, from the morphological point of view, it is very similar to the dishes normally used for eating.
Anatomy
Introduction: to fully understand the following anatomical description of the tibial plateau, readers are advised to look at the figures relating to the tibia.
The proximal end of the tibia is a visibly enlarged area, in which it is possible to recognize two obvious prominences, called the medial condyle (placed towards the inner leg) and the lateral condyle (disposed towards the outside leg).
The tibial plateau is the upper surface of the medial and lateral condyles of the proximal end of the tibia.
General anatomical features
Like all articular surfaces, the tibial plateau appears as a smooth region ; the absence of roughness that distinguishes the tibial plateau is fundamental for the correct mobility of the knee joint.
The anatomical descriptions typical of the tibial plateau speak of the latter as a mostly oval area, divided into two parts, called medial tibial plateau and lateral tibial plateau, whose separation element is the so-called intercondylar area .
Medial tibial plate, lateral tibial plate and intercondylar area will be treated more broadly in the next three paragraphs.
MEDIUM TIBIAL PLATE
The medial tibial plateau is the portion of the tibial plateau above the medial condyle of the proximal end of the tibia; in other words, it is the upper surface of the tibial condyle disposed towards the inside of the leg.
Obviously smooth, the medial tibial plateau has a predominantly oval shape, is concave and, from a dimensional point of view, is wider than the lateral tibial plateau.
Meaning of medial and lateral
In anatomy, medial and lateral are two terms of opposite meaning, which serve to indicate the distance of an anatomical element from the sagittal plane . The sagittal plane is the anteroposterior division of the human body, from which two equal and symmetrical halves are derived.
Mediale means "near" or "closer" to the sagittal plane, while lateral means "far" or "farther" from the sagittal plane.
SIDE TIBIAL PLATE
The lateral tibial plateau is the portion of the tibial plateau which resides above the lateral condyle of the proximal end of the tibia; in other words, it is the upper surface of the tibial condyle disposed towards the outside of the leg.
Clearly devoid of roughness and rough areas, the lateral tibial plateau has a more circular than an oval shape, is convex and, from a dimensional point of view, is less extensive than the medial tibial plateau.
INTERCONDILOID AREA
Interposed between the medial tibial plateau and the lateral tibial plateau, the intercondylar area is an important region because:
- In the center, it has two pyramid-shaped bone processes, called medial intercondylar tubercle and lateral intercondylar tubercle, which have the task of hooking the medial meniscus and the lateral meniscus of the knee;
- Anteriorly, it presents a rough depression, called anterior intercondylar fossa, on which the tibial head of the anterior cruciate ligament of the knee finds insertion;
- Later, it has a second rough depression, identified with the term of posterior intercondylar fossa, on which the tibial head of the posterior cruciate ligament of the knee is inserted.
The intercondylar area, therefore, is a region of the tibial plateau essential to the constitution of the knee joint.
Deepening: the intercondylar eminence
Together, the medial intercondylar tubercle and the lateral intercondylar tubercle form the anatomical element of the intercondylar area known as the intercondylar eminence .
The intercondylar eminence represents, in fact, the bony prominence that separates the anterior intercondylar fossa from the posterior intercondylar fossa; moreover, it has a physiognomy such that it fits perfectly in the so-called intercondylar fossa (or intercondylar fossa ) present on the femur, that is the thigh bone with which the tibia forms the knee joint.
Function
The tibial plateau is part of the constituent elements of the knee joint.
Within this context, its tasks are:
- Hook the meniscuses, which are essentially shock-absorbing bearings;
- Hook the tibial head of the anterior cruciate ligament and the posterior cruciate ligament, ligaments that are fundamental for the correct mobility and stability of the knee;
- Thanks to its extremely smooth surface, it facilitates the slipping of the distal end of the femur onto the tibia during knee movements.
The tibial plateau also contributes significantly to the supporting action carried out by the tibia, with respect to the upper part of the human body; in fact, it is at the culmination of a specially large bone portion, so that it can bear the weight of what is above it (the trunk, the head, etc.).
diseases
The tibial plateau is a very fragile bone portion; therefore, if subjected to traumas of a certain entity, it can easily be subject to fracture.
Tibial plateau fractures are the most typical example of skeletal injuries to the proximal end of the tibia.
Causes of tibial plateau fracture and risk factors
In most cases, the episodes of fracture of the tibial plateau result from accidental falls, strong bruises in sports and motor vehicle or motorcycle accidents.
Normally, the tibial plateau undergoes rupture, when a trauma to the lower limbs involves a violent collision between the tibia and the distal end of the femur.
RISK FACTORS
Factors such as osteoporosis, osteopenia, sports practice in which physical contact (eg, rugby, American football, football, etc.) and age are increased increase the risk of suffering a tibial fracture. advanced.
Epidemiology of tibial plateau fractures
Statistics say that:
- Tibial plateau fractures make up 1% of all fracture episodes that can affect the bones of the human body;
- Within the male population, men who are more likely to develop a tibial plateau fracture are men in their 40s;
- Within the female population, the subjects most susceptible to tibial plateau rupture are women around 70 years old.
Symptoms and signs of tibial plateau fractures
The typical symptoms and signs of a tibial plateau fracture are:
- Pain in the leg portion closest to the knee;
- Swelling (or edema) to the leg portion closest to the knee;
- Formation of a blood effusion almost in correspondence of the knee (articular blood effusion or hemarthrosis);
- Reduced joint mobility of the knee;
- Lame and difficulty in resting on the ground and loading (with the weight of the body) the suffering leg.
Since several blood vessels and nerves flow in the vicinity of the tibial plateau, traumatic events of a certain relevance (obviously affecting the tibial plateau) can cause damage to these vessels and nerves, with different repercussions on painful symptoms, the presence of hemarthrosis and on skin sensitivity.
COMPLICATIONS
If it is particularly severe, the edema resulting from a fracture of the tibial plateau can compress the blood vessels and neighboring nerves, to the point that they are unable to perform their normal functions. In other words, when it is considerable, the swelling resulting from the tibial plateau rupture can interrupt the flow of blood to the neighboring tissues and the motor and cutaneous control of the latter.
In medicine, this particular situation is called compartment syndrome .
The compartment syndrome is, without a doubt, the most important complication of the tibial plateau fracture episodes.
Other possible complications of tibial plateau fractures:
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Diagnosis of tibial plateau fractures
The diagnosis of tibial plateau fracture is typically based on: physical examination, medical history and diagnostic imaging tests, such as X-rays, CT or MRI, obviously related to the leg.
To be precise, in the diagnostic procedure that leads to the identification of a tibial plateau rupture, the diagnostic imaging tests represent confirmatory investigations of what emerged during the physical examination and the anamnesis.
Beware of X-rays
Unfortunately, some fractures of the tibial plateau are not observable with X-rays, in the sense that the latter cannot identify them. This possibility can lead the diagnostic doctor not to readily notice the injury in progress.
Tibial plateau fracture therapy
Treatment of a tibial plateau fracture can be conservative or surgical .
It is conservative when:
- The fracture is of intermediate / contained gravity;
- No complications are in progress;
- The patient is healthy and healthy.
On the contrary it is surgical, when:
- The fracture is severe;
- Complications are underway (eg, compartment syndrome, rupture of the anterior cruciate ligament, etc.);
- The patient is in a precarious state of health or is older.
CONSERVATIVE TREATMENT OF A TIBIAL PLATE FRACTURE
In general, the conservative treatment of a tibial plateau fracture involves: plastering of the injured lower limb up to the formation of the callus, absolute rest also in this case up to the formation of the callus, the use of crutches (for avoid loading the body weight on the affected leg) and taking anti-inflammatory drugs (eg NSAIDs ) against pain.
SURGICAL TREATMENT OF A TIBIAL PLATE FRACTURE
There are several surgical techniques to treat a serious tibial plateau fracture; among these techniques, the two most important and worthy of a quotation are the so-called external fixation and the so-called internal fixation .
During external fixation operations, the surgeon welds the tibial plateau fracture by applying screws and pins from the outside (so they are visible); on the occasion of internal fixation interventions, on the other hand, the surgeon restores the fracture of the tibial plateau by applying screws and pins from the inside, after a special incision of the injured leg (screws and pins are therefore not visible).
As can be guessed, after the surgical therapy, the patient who suffered a fracture of the tibial plateau must observe an absolute rest period, bring a plaster to the injured lower limb and use the crutches, all up to the formation of the callus.
Recovery times from a tibial plateau fracture
A tibial plate fracture of limited gravity (conservative treatment) heals over 8-12 weeks ; a severe tibial plate fracture (surgical treatment), on the other hand, has healing times that can exceed 4 months .
