Tibial Plateau Fracture Treatment

The tibial plateau is the flat upper surface of the shin bone forming the lower half of the knee joint. A fracture here is not simply a broken bone, it is a break in a weight bearing joint surface, and the central problem is usually that a portion of that surface has been driven downward into the bone beneath it.

Steven Struhl, MD is board certified in orthopedic surgery and separately in sports medicine, serves as an attending surgeon at NYU Hospital for Joint Diseases, and has practiced in New York since 1991. Tibial plateau fractures are planned on CT rather than on plain films, because the depression of the joint surface is the problem and plain radiographs consistently understate it.

How Tibial Plateau Fractures Happen

• Falls in Older Adults: low energy injuries in bone weakened by osteoporosis, where a fall from standing is sufficient.
• Motor Vehicle Collisions: including bumper injuries striking the outer knee directly.
• Falls From Height: axial load driving the femur down into the tibial surface.
• Sports Injuries: skiing and contact sport producing a combination of impact and twisting.
• Associated Soft Tissue Injury: ligament and meniscus damage accompanying these fractures frequently, which changes the treatment plan.

Types of Tibial Plateau Fracture

The pattern determines the treatment, and the useful distinctions are which side is involved and whether the surface has been depressed.

• Lateral Plateau Fractures: the most common, from force applied to the outer side of the knee.
• Medial Plateau Fractures: less common and generally indicating higher energy injury.
• Bicondylar Fractures: both sides involved, the most severe pattern, and often with soft tissue compromise.
• Split Fractures: the surface cracked without being driven downward.
• Depression Fractures: a segment of the joint surface pushed down into the underlying bone.
• Split Depression Fractures: a combination of the two, and the most frequently encountered pattern.

Tibial Plateau Fracture Symptoms

• Severe Pain and Inability to Bear Weight: immediate after the injury.
• Marked Swelling: blood filling the joint rapidly.
• Deformity: angulation of the leg where the surface has collapsed on one side.
• Restricted Motion: the knee resisting any attempt to bend or straighten.
• A Tense, Firm Compartment: with severe pain out of proportion to the injury, which raises the concern of compartment syndrome and is an emergency.
• Numbness or Coolness: indicating nerve or vascular involvement.

Diagnosis and Why CT Matters

Radiographs identify the fracture and give a general impression of the pattern. CT is the study surgical planning is built on, because plain films consistently understate how far a joint surface has been depressed, and the amount of depression is precisely what determines whether the fracture is fixed and how. MRI is added where ligament or meniscus injury is suspected, which is frequent, since the same force that fractures the plateau commonly damages the soft tissue alongside it.

Non Surgical Treatment

• Minimally Displaced Fractures: a joint surface still congruent, with depression within acceptable limits.
• Stable Patterns: fractures that will hold their position through healing.
• Hinged Bracing: protecting the knee while permitting controlled motion.
• Non Weight Bearing: typically for eight to twelve weeks, which is longer than most patients expect.
• Early Motion: started promptly, since a knee immobilized through healing becomes stiff.
• Serial Radiographs: confirming the surface has not collapsed further under load.

Surgical Treatment for Tibial Plateau Fractures

• Open Reduction and Internal Fixation: the depressed segment elevated back to level and held with a plate and screws.
• Bone Grafting: filling the void left beneath the elevated surface, using graft or bone substitute, to stop it from collapsing again.
• Arthroscopic Assistance: used in selected fractures to confirm the joint surface directly and treat associated meniscus injury.
• External Fixation: applied temporarily in high energy injuries where the soft tissue envelope will not tolerate immediate surgery.
• Staged Treatment: stabilizing first and reconstructing definitively once swelling settles, which is standard in severe patterns.

Rehabilitation and Long Term Outlook

• Weeks One to Twelve: non weight bearing or protected weight bearing, with knee motion begun early.
• Weeks Six to Twelve: motion advanced and quadriceps strengthening started.
• Months Three to Six: weight bearing progressed as healing is confirmed, with strengthening and gait retraining.
• Months Six to Twelve: return to full activity, with the final result settling across the first year.

Because these fractures involve a weight bearing surface, the long term concerns are loss of knee motion, instability where ligaments were also injured, and post traumatic arthritis. The quality of the joint surface restoration is the strongest predictor of all three, which is why these fractures are planned carefully and fixed to millimeter tolerances.

Schedule a Tibial Plateau Fracture Consultation in New York City

A tibial plateau fracture treated without CT has been planned on incomplete information, and a knee that is not regaining motion after one deserves a prompt second look. Dr. Struhl treats knee fractures at his Manhattan and Westchester offices. Contact our orthopedic practice to schedule a consultation.