FRACTURES OF THE TIBIAL PLATEAUS

In cases of fracture of the tibial plateau the question whether to use open or closed methods of treatment must be answered by considering all the factors that may determine the degree of permanent residual disability. Since continued use of a deformed knee is likely to cause late arthritic changes, deformity that cannot otherwise be corrected is the primary indication for surgical procedures. In a series of 63 fractures of this kind, open reduction was considered necessary in only 7. The closed, nonoperative treatment used in the other 56 cases included these features: aspiration of free blood and joint fluid, manipulation with the patient under general anesthesia to correct deformity, skeletal traction, early motion, transfer from splint to brace, protection during the period of healing, and a program of exercises begun early and continued over a period of months. Unprotected weight-bearing cannot be permitted until union is solid (about six months), and a certain amount of permanent residual disability may be expected.