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Tibial Plateau Fracture: Causes, Symptoms & Treatment

A tibial plateau fracture is a break at the upper end of the shinbone, affecting the knee joint. It often requires surgical treatment for full recovery.

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A tibial plateau fracture is a break at the upper end of the shinbone, affecting the knee joint. It often requires surgical treatment for full recovery.

What Is a Tibial Plateau Fracture?

A tibial plateau fracture is a break in the upper portion of the tibia (shinbone), specifically at the tibial plateau – the flat, weight-bearing surface that forms the lower part of the knee joint. Because this area is critical for knee stability and movement, such fractures can significantly impair knee function and require prompt medical attention.

Causes

Tibial plateau fractures typically result from high-energy trauma or, in older individuals, from low-energy injuries due to reduced bone density. Common causes include:

Motor vehicle accidents (direct impact to the knee)
Falls from height
Sports injuries (skiing, football, cycling)
Direct blows to the knee
Osteoporosis: In elderly patients, even minor trauma can cause a fracture due to weakened bone structure.

Classification

The most widely used classification system is the Schatzker classification, which divides tibial plateau fractures into six types:

Type I: Pure split fracture of the lateral plateau
Type II: Split and depression fracture of the lateral plateau
Type III: Pure depression fracture of the lateral plateau
Type IV: Fracture of the medial plateau
Type V: Bicondylar fracture (both plateaus involved)
Type VI: Bicondylar fracture with dissociation of the metaphysis and diaphysis

Higher Schatzker types generally indicate more complex and severe injuries.

Symptoms

Common signs and symptoms of a tibial plateau fracture include:

Severe pain around the knee joint
Swelling and bruising (hematoma) of the knee
Limited range of motion in the knee
Inability to bear weight on the affected leg
Possible malalignment of the knee (varus or valgus deformity)
In severe cases: vascular or nerve injury causing numbness or circulatory problems

Diagnosis

Diagnosis is established through clinical examination and imaging studies:

X-ray: The initial imaging modality to identify the fracture
Computed tomography (CT): Provides detailed assessment of fracture pattern and fragment displacement – essential for surgical planning
Magnetic resonance imaging (MRI): Evaluates associated soft tissue injuries such as ligament, meniscal, or cartilage damage
Angiography: Used when vascular injury is suspected

Treatment

Non-Surgical Treatment

Non-displaced or minimally displaced fractures without joint instability may be managed conservatively:

Immobilization and protected weight-bearing (crutches, knee orthosis)
Physiotherapy to restore mobility and muscle strength
Regular follow-up X-rays to monitor healing

Surgical Treatment

Most tibial plateau fractures require surgical fixation to restore the joint surface and ensure stable healing. Common surgical approaches include:

Screw fixation: Stabilization of fragments with screws
Plate osteosynthesis: Use of metal plates and screws (e.g., locking plates) for stable fixation
Arthroscopically assisted reduction: Minimally invasive technique for joint surface reconstruction
Bone graft or bone substitute: Used to fill defects in depression fractures

Rehabilitation

Rehabilitation is critical to achieving a good functional outcome:

Gradual return to weight-bearing as directed by the surgeon
Physiotherapy for joint mobilization, muscle strengthening, and gait training
Continuous passive motion (CPM) therapy in selected cases
Full recovery may take several months

Complications

Potential complications associated with tibial plateau fractures include:

Post-traumatic osteoarthritis of the knee
Compartment syndrome (elevated pressure within muscle compartments)
Deep vein thrombosis or pulmonary embolism
Wound infection or implant failure following surgery
Malalignment or chronic knee instability

References

Schatzker J, McBroom R, Bruce D. The tibial plateau fracture: the Toronto experience 1968–1975. Clinical Orthopaedics and Related Research, 138:94–104, 1979.
Wasserstein D, Henry P, Paterson JM et al. Risk of total knee arthroplasty after operatively treated tibial plateau fracture. Journal of Bone and Joint Surgery, 96(2):144–150, 2014.
Zeltser DW, Leopold SS. Classifications in brief: Schatzker classification of tibial plateau fractures. Clinical Orthopaedics and Related Research, 471(2):371–374, 2013.

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