Insufficiency fracture of the tibial plateau: an often missed diagnosis.

The authors have performed a retrospective study of 8 patients, all elderly females, seen in the period 2002-2004 with insufficiency fractures of the tibial plateau. Their mean age was 74 years (range 70-84). There was a history of trivial trauma in all patients, except one. Three of the patients were referred to the orthopaedic department, as a fracture line was visible on the plain radiographs taken 3 to 6 weeks after the trauma. The remaining five patients presented immediately after the trauma, which explains why their radiographs were still negative or only showed osteoarthritis. In the same 5 patients a diagnosis of tibial plateau fracture was made by CT-scan in 3, and by MRI-scan in 2 patients. All patients except one had a DEXA-scan, which revealed osteopenia in 4 and osteoporosis in 3 patients; all 7 were treated with bisphosphonates. All 8 patients were treated conservatively with a cast brace, for 6 to 12 weeks, with a good result. Insufficiency fracture of the tibial plateau is an often missed diagnosis. Plain radiographs are frequently negative in the beginning. Delayed diagnosis can cause pain and disability to the patient and can lead to deformity of the knee joint, due to structural collapse. MRI is sensitive to bone marrow oedema/ bone bruising, even in the osteoporotic tibial condyle. Once the diagnosis is made, the results are good with non-operative treatment.