Fracture--dislocation of the knee.

Fractures of the proximal tibia involving the articular surfaces vary greatly in type, severity, and prognosis, and a considerable percentage have significant associated ligamentous injuries. This report classifies and analyzes 132 particular fractures separated from over 1,000 patients with fractures of the proximal tibia. The remaining cases were considered to have tibial plateau fractures. Eighty-six fractures required operative treatment, and it was possible to divide them into five distinct types. The characteristic of these five types is marked joint instability with a high incidence of serious soft-tissue and/or neurovascular injury. Knee dislocation is a discrete entity. Plateau fracture is a discrete entity that requires definition (and which in large measure has little or no implication of significant soft-tissue injury). Fracture--dislocation of the knee is a much more serious injury than plateau fracture. For successful treatment of this injury, a radically different understanding of fractures of the proximal tibial condyles is needed.