Tibial Plateau Fracture Fixation

Indications

Tibial Plateau Fractures, imaging of a lateral tibial plateau fracture
Imaging of a lateral tibial plateau fracture. Image by LottieLattes, Wikimedia Commons, CC BY-SA 4.0.
  • Articular step or condylar widening
  • Malalignment and instability
  • Spanning external fixation first when soft tissues are poor
  • Schatzker classification and CT based three column concepts guide fixation
  • Articular step over about 2 mm and condylar widening over 5 mm are common thresholds
  • Undisplaced fractures are treated in a hinged brace

Position

  • Supine, radiolucent table, bump under the hip
  • Image intensifier from the opposite side
  • Thigh tourniquet available

Operative Steps

  1. CT to plan approaches and fragment fixation
  2. Anterolateral approach with submeniscal arthrotomy for lateral fractures
  3. Elevate depressed articular fragments through a cortical window
  4. Fill the void with graft or substitute, support with rafter screws
  5. Lateral buttress or locking plate
  6. Posteromedial approach for medial or bicondylar fractures, with dual plating
  7. Avoid a single midline incision with wide stripping
  8. Repair the meniscus
  9. Check the lateral meniscus, which is often trapped in the fracture
  10. Restore the mechanical axis and joint line height
  11. Hybrid or ring frames for comminuted bicondylar fractures with poor skin

Postoperative Care

  • Early motion, protected weight bearing for 6 to 12 weeks
  • Radiographs at 2, 6 and 12 weeks
  • CPM is not essential if active motion starts early

Complications

  • Wound breakdown and deep infection
  • Compartment syndrome
  • Loss of reduction and post-traumatic arthritis
  • Common peroneal nerve injury
  • Knee stiffness
  • Peroneal nerve injury with lateral approaches
  • Malalignment

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.