Is Tibial Plateau Fracture Considered a Closed Fracture Without Blood?

Is a tibial plateau fracture considered a closed, non-displaced fracture?

Hello Dr.
Yeh, is the surgical procedure for tibial plateau fracture reduction considered a closed fracture surgery without visible blood? A steel plate was installed on the right leg.
How can we distinguish between a fracture with visible blood and one without? Thank you.

Lolita, 40~49 year old female. Ask Date: 2017/08/25

Dr. Chen Yongxue reply Orthopedics

Hello, first, surgery for tibial plateau fractures typically requires an open reduction, as it cannot be treated with closed reduction.
Second, during the surgical procedure, a tourniquet is used, so there will be minimal bleeding during the operation; however, it is normal to have some slight oozing postoperatively.
Third, fractures will always result in bleeding; in the case of closed fractures, the bleeding occurs internally, and bruising may appear within 5-7 days.
Clinically, there is no distinction between whether blood is visible or not.
Thank you.

Reply Date: 2017/08/25

More Info

A tibial plateau fracture is a type of fracture that occurs at the top of the tibia (shinbone) where it meets the knee joint. This type of fracture can be classified as either open or closed, depending on whether the skin is broken and whether there is exposure of the bone to the external environment.

In your case, if the tibial plateau fracture was treated with a reduction (surgical realignment) and there was no visible wound or break in the skin, it would be classified as a closed fracture. Closed fractures do not involve any puncture or laceration of the skin, meaning that there is no external bleeding associated with the fracture site. Conversely, an open fracture (also known as a compound fracture) occurs when the bone breaks through the skin, which can lead to bleeding and a higher risk of infection.

To determine whether a fracture is open or closed, medical professionals typically assess the injury visually and may perform imaging studies such as X-rays or CT scans. If there is no visible wound and the skin remains intact, it is generally considered a closed fracture. However, if there is any break in the skin or if the fracture is associated with significant soft tissue injury, it would be classified as an open fracture.

In the context of your surgery, if you had a tibial plateau fracture and underwent a surgical procedure to stabilize it with a plate and screws, and there was no external bleeding or skin breach, it is indeed classified as a closed fracture. The surgical procedure itself may involve incisions to access the fracture site, but this does not change the classification of the fracture itself.

It's important to follow your surgeon's post-operative care instructions closely to ensure proper healing. This may include weight-bearing restrictions, physical therapy, and regular follow-up appointments to monitor the healing process through imaging studies. If you experience any unusual symptoms, such as increased pain, swelling, or signs of infection (like redness or discharge from the surgical site), you should contact your healthcare provider immediately.

In summary, a tibial plateau fracture can be classified as a closed fracture if there is no break in the skin and no visible bleeding. Proper assessment and imaging are essential to confirm the classification of the fracture and to guide appropriate treatment. Always consult with your orthopedic surgeon for personalized advice and follow-up care tailored to your specific situation.

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