Tibial Plateau Fracture
Definition & Mechanism
A tibial plateau fracture involves the articular surface of the proximal tibia. It results from an axial load combined with a valgus (or varus) force — e.g. A car bumper striking the lateral side of the knee (‘bumper fracture’) or a fall from height. Because it is intra-articular, accurate reduction is essential to avoid arthritis.
Clinical Features
A swollen, painful knee with a haemarthrosis and inability to bear weight. Assess for associated ligament injury (collaterals, cruciates), meniscal tears, neurovascular injury (popliteal artery, common peroneal nerve, especially in high-energy medial/bicondylar fractures) and compartment syndrome.
| Schatzker | Pattern |
|---|---|
| I | Lateral plateau — pure split (wedge) |
| II | Lateral plateau — split + depression |
| III | Lateral plateau — pure depression |
| IV | Medial plateau fracture (high-energy) |
| V | Bicondylar (both plateaus) |
| VI | Plateau # with metaphyseal–diaphyseal dissociation |
CLINICAL PEARL
Schatzker IV–VI are high-energy injuries — actively look for neurovascular damage, compartment syndrome and the ‘floating knee’; a fracture-dislocation of the knee can occlude the popliteal artery.
Investigations
AP and lateral radiographs; CT is standard to define articular depression and comminution and to plan surgery. MRI if ligamentous/meniscal injury is suspected.
Management
Undisplaced or minimally depressed fractures (articular step < ~2–3 mm) may be treated in a hinged brace with protected weight-bearing and early movement. Displaced/depressed fractures need open (or arthroscopically assisted) reduction, elevation of the depressed segment, bone grafting of the defect and buttress-plate fixation to restore a congruent joint surface and the mechanical axis. High-energy V/VI patterns may be temporised with a spanning external fixator until soft tissues recover.
Complications
Early: compartment syndrome and popliteal vascular injury (high-energy IV–VI patterns), and wound problems. Late: post-traumatic osteoarthritis from an incongruent joint or residual axial malalignment, knee stiffness, and instability from associated ligament injury.
Look for associated ligament and meniscal injury.
KEY POINT
Key points TO remember
- Intra-articular proximal tibia; axial + valgus/varus force (bumper injury).
- Schatzker I–III lateral, IV medial, V bicondylar, VI with shaft dissociation.
- CT for planning; exclude popliteal artery / peroneal nerve injury & compartment syndrome.
- Undisplaced → brace; displaced → reduction, graft the defect, buttress plating.
EXAM TIP
Sources: Maheshwari's Essential Orthopaedics; Apley & Solomon's System of Orthopaedics and Trauma; AO Principles of Fracture Management.
All questions in Lower Limb Trauma
- Q1Define Fracture of the Neck of the Femur. Describe its classification, clinical features, investigations and management. ★
- Q2Define Intertrochanteric Fracture of the Femur. Describe its classification, investigations, management and complications. ★
- Q3Define Fracture of the Shaft of the Femur. Describe its clinical features, investigations, management and complications. ★
- Q4Define Fracture of Both Bones of the Leg & Compartment Syndrome. Describe its clinical features, investigations, management and complications. ★
- Q5Define Ankle Injuries & Fractures. Describe its clinical features, investigations, management and complications. ★
- SN1Define Fracture of the Patella. Describe its clinical features, classification and management. ★
- SN2Define Calcaneal Fracture. Describe its clinical features, investigations and management.
- SN3Tibial Plateau Fracture
- SN4Define Acute Compartment Syndrome. Describe its pathophysiology and management. ★
- SN5Define Fat Embolism Syndrome. Describe its pathogenesis, clinical features, investigations and management.
- SN6Describe Fracture of the Neck of the Talus in detail.
- SN7Define Pilon (Plafond) Fracture. Describe its clinical features, investigations and management.