Treatment of Combined Tibial Plateau and Shaft Fractures

Separate ipsilateral tibial plateau and shaft fractures are rare and complicated injuries. They are associated with high energy mechanisms and may present with significant soft tissue as well as life threatening nonorthopaedic trauma. Meticulous preoperative planning is essential when determining the appropriate fixation construct. Utilization of a single locking plate in a minimally-invasive fashion is a common fixation option. Unfortunately, this fixation method is technically demanding and may not provide the optimal biomechanical environment needed for healing of the plateau and/or shaft fracture leading to nonunion and possible hardware failure. This paper describes fixation techniques for ipsilateral tibial plateau and shaft fractures that combine suprapatellar intramedullary nailing of the shaft with separate plate fixation of the tibial plateau. While also technically demanding, with close attention to preoperative planning, these techniques allow for fracture specific fixation of both the tibial plateau and shaft. In doing so, the ideal implant for each fracture is utilized which optimizes the environment for subsequent fracture healing and return to function.