A Rare Case of Hyperextended Bicondylar Tibia Plateau Fracture
Authors: Jadawala Vivek , Taywade Shounak , Salwan Ankur , Pisulkar Gajanan , Shah Parth 
Published: March 2023

Bicondylar tibia plateau fractures are a common injury in day-to-day practice, and categorization and treatment methods have been effectively described in the literature. The Hyperextension bicondylar tibia plateau (HEBTP) fracture is an uncommon fracture that is difficult to classify using standard classification techniques and has no set treatment strategy. Compressed anterior cortex, tension stress failure of the posterior cortex and loss of normal posterior slope of tibia plateau are all symptoms of HEBTP, which is produced by hyperextended high-energy trauma. HEBTP fracture is a kind of tibia plateau fracture which largely affects the tibial condyle' sagittal alignment. They account for fewer than 20% of all bicondylar injuries. As the knee has varus alignment and restraint of the knee's posterolateral capsule-ligamentous complex, there is asymmetric accumulation of force to the medial plateau resulting in a characteristic injury pattern that is often more severe on this side. Hence, we discuss a case of HEBTP managed with bicondylar plate and its functional outcomes. We present a case of a 44-year-old male patient who came to Acharya Vinoba Bhave Rural Hospital, Wardha with 5-day-old history of high-energy trauma to the right knee, with discomfort and swelling over the right knee and inability to bear weight over the right lower limb. The patient initially went to a local doctor and was treated conservatively with an above knee slab over his right lower limb before being sent to AVBRH for further treatment. On examination, there was extensive edema and varus deformity over the right proximal tibia. The tibia had substantial posterior sag, which is unusual in a tibial plateau fracture. Tenderness was present across the proximal one-third of the tibia, although there was no increase in local temperature. Range of motion in the knees was not possible. Clinically, there was a 10° varus deformity. The posterolateral ligament complex and collateral ligaments could not be evaluated. There were no symptoms of compartment syndrome present. There was no neurovascular injury. Distal circulation was intact. The differential diagnosis was posterolateral corner injury, posterior subluxation, or dislocation of the knee. To rule out the differentials, radiological imaging, X-ray, and a computed tomography scan were performed and the patient was diagnosed to have hyperextended bicondylar tibia plateau fracture. Open reduction and internal fixation with bicondylar plate osteosynthesis were used to treat the patient and extensive postoperative physiotherapy regimen was started. The patient was then followed up and results were recorded. The treatment for hyperextension tibia plateau fractures includes reducing fractures while healing critical ligament damage and restoring knee joint stability. If the tibial rim is depressed, the tibial rim should be rebuilt to restore the joint's stability. The features of anterior tibia fractures produced by knee hyperextension injuries are unknown at this time. For anterior tibia plateau fractures, there is very less unanimity on the best technique and fixing methods. The clinical dilemma of deciding how to decrease as well as cure the fractures of the anterior tibia plateau produced by the hyperextension injury remains unsolved. The treatment of hyperextension bicondylar tibia plateau fractures managed with open reduction and bicondylar plate osteosynthesis yields outstanding outcomes.