Anteromedial Tibia Plateau Fracture without Significant Ligamentous Injury Treated Successfully with Open Reduction and Internal Fixation: A Case Report.

Background: Anteromedial tibial plateau fractures are an unusual pattern of injury, mostly caused by high-energy trauma in conjunction with knee hyperextension and varus force. This type of fracture is usually accompanied by extensive soft tissue injuries, especially the posterior cruciate ligament, the posterolateral corner, and, rarely, the medial meniscus.

Case report: A 44-year-old medically free male sustained a hyperextension injury to his left knee after being kicked by a horse. Imaging showed an anteromedial tibial plateau rim fracture, as well as a fibular head fracture. Examination under anesthesia revealed a stable knee. Open reduction and internal fixation were conducted using a 3.5 locking compression plate L-shaped plate, and screws. Post-operative outcomes at 7 months of follow-up, the patients had complete knee mobility, no significant ligamentous damage, and returned to regular activities without discomfort.

Conclusion: This case illustrates that anteromedial tibial plateau fractures may occasionally occur without overt ligamentous injury. However, the absence of pre-operative magnetic resonance imaging and reliance on intraoperative manual testing limits the ability to exclude subclinical soft tissue damage. While stable fixation using an anteromedial approach resulted in favorable short-term outcomes, further studies and long-term follow-up are necessary to determine the durability of function and joint stability.