Complete articular fracture with fragmentary medial plateau

Multifragmentary articular fractures characterized by the involvement of both the medial and lateral condyles are classified by the AO/OTA as 41C3 fractures. A complete articular fracture with fragmentary medial plateau is classified as 41C3.2. The metaphyseal part of the fracture may be multifragmentary as well.

They usually result from high-energy injuries. In addition to the bicondylar fragmentation there is metaphyseal comminution with loss of continuity between the proximal epiphysis and the diaphysis.

A coronal plane fracture of the medial plateau is commonly seen. This often results in a separate posteromedial fracture fragment. The anteromedial tibial plateau may or may not be separated from the metadiaphysis. Comminution of the medial articular surface may be present along the coronal fracture plane.

A major concern in managing these severe injuries is the invariably present severe soft-tissue envelope injury. Treatment of these fractures is extremely challenging and requires careful judgment and technical expertise.

This image shows a bicondylar plateau fracture with significant soft-tissue compromise. The leg is prepped for application of temporary spanning fixation.