A tibial plateau fracture is a break in the upper surface of the tibia, the weight-bearing surface of the knee joint. These are complex intra-articular fractures in most cases, and accurate restoration of the joint surface is critical because post-traumatic arthritis is common when articular congruity is not restored. Treatment depends on fracture displacement, depression of the articular surface, soft-tissue status, and associated ligament or meniscus injury.
What Is a Tibial Plateau Fracture?
The tibial plateau is the top surface of the tibia where it articulates with the femur through the menisci. The plateau has a medial and lateral side, each bearing load through one of the menisci and communicating with the central eminence, which anchors the ACL and PCL.
Tibial plateau fractures are classified by the Schatzker system:
- Type I: lateral plateau split
- Type II: lateral plateau split with depression (the most common pattern)
- Type III: pure lateral plateau depression without split
- Type IV: medial plateau fracture (high-energy, often with associated ligament injury)
- Type V: bicondylar fracture (both plateaus)
- Type VI: plateau fracture with separation of the metaphysis from the diaphysis
Higher Schatzker types reflect higher-energy mechanisms and carry higher rates of associated soft-tissue injury, neurovascular involvement, and compartment syndrome.
Causes and Risk Factors
- High-energy trauma: motor vehicle collisions, falls from height
- Low-energy falls in older patients with osteoporotic bone
- Skiing accidents with twisting forces
- Pedestrian versus motor vehicle mechanisms
- Contact sport collisions
Symptoms
- Severe knee pain and swelling after the injury
- Inability to bear weight
- Visible deformity in high-energy patterns
- Tense swelling that may indicate compartment syndrome or hemarthrosis
- Associated soft-tissue injury: skin contusion, fracture blisters
- Peroneal nerve symptoms in lateral-sided injuries
Diagnosis
Dr. Chudik’s evaluation prioritizes neurovascular assessment and compartment syndrome screening. Pulses, sensation, motor function, and compartment tension are documented. X-rays in multiple views define the fracture. CT is obtained for surgical planning on all displaced fractures because the axial and coronal reconstructions reveal depression and split patterns that are difficult to appreciate on X-ray alone. MRI is added when ligament or meniscus injury is suspected. The Westmont office has on-site high-field MRI and X-ray.
Treatment
Non-surgical treatment is appropriate for non-displaced and minimally depressed fractures (less than 2 to 3 mm of articular step-off). It involves a hinged knee brace, protected weight-bearing for six to eight weeks, and progressive range of motion.
Surgical treatment is indicated for displaced fractures, articular depression greater than 2 to 3 mm, fractures associated with ligament injury, open fractures, and fractures with compartment syndrome or neurovascular compromise. Dr. Chudik performs open reduction and internal fixation with:
- Plate and screw fixation for most Schatzker II, III, and IV fractures
- Bone grafting or bone substitute to support the reduced articular surface
- External fixation as an initial damage-control measure for high-energy patterns with significant soft-tissue compromise
- Dual-plate fixation for bicondylar patterns
Associated meniscus tears are repaired arthroscopically, and significant ligament injuries are addressed in the same or a staged procedure.
Recovery and Outcomes
Recovery after internal fixation typically includes protected weight-bearing for 8 to 12 weeks, progressive range of motion starting within days to minimize stiffness, and progressive weight-bearing and strengthening over three to six months. Return to daily activity is typically three to six months. Return to sport, when possible, is usually six to 12 months.
Outcomes depend on the quality of articular reduction, associated soft-tissue injury, and the patient’s bone quality. Post-traumatic arthritis is common in high-energy patterns and in fractures where articular congruity was not fully restored.
When to See Dr. Chudik
Schedule urgent evaluation after any significant knee injury with inability to bear weight, severe swelling, or concern for fracture. Call 630-324-0402 or request an appointment online.