Experimentally produced tibial plateau fractures

Tibial plateau fractures are among the most severe lower limb injuries suffered in car crashes in terms of long-term impairment. Axial loading of a flexed, entrapped knee by an impact delivered to the plantar surface of the foot is a likely injury scenario for a number of lower limb injuries sustained in frontal crashes, including tibial plateau fractures. In order to determine the injury tolerance of the leg to axial loading, axial impact tests at injurious load levels were conducted using 20 above-knee cadaver leg specimens in which the ankle was neutrally positioned and the knee was constrained and flexed 90°. Injury to the foot/ankle complex was generated in 15 specimens, and tibial plateau fractures were generated in 5 of these specimens. All tibial plateau injuries were Schatzker VI type bicondylar fractures associated with severe comminution and disruption of the articular surface. However, the fact that tibial plateau fractures never occurred independently of foot and ankle injury suggests that an axial loading injury criterion based on the injury tolerance of the foot/ankle complex is sufficiently conservative to protect against tibial plateau fractures in this impact scenario.