Tibial Plateau — Schatzker

Tibial plateau fractures involve the proximal articular surface of the tibia and represent approximately 1% of all fractures and about 8% of fractures in the elderly population. These fractures are clinically significant because they involve the weight-bearing surface of the knee joint and may lead to instability, malalignment, and post-traumatic arthritis if not properly treated.

Tibial plateau fractures typically occur following axial loading forces applied to the knee joint. In younger individuals, these injuries are usually caused by high-energy trauma such as road traffic accidents or falls from height. In elderly patients with osteoporotic bone, low-energy falls may produce similar fracture patterns.

Proper diagnosis, classification, and management are essential for restoring joint congruity and preventing long-term functional impairment. The Schatzker classification system is the most widely used method for categorizing tibial plateau fractures.

The tibial plateau forms the proximal articular surface of the tibia and articulates with the femoral condyles to form the knee joint. It consists of medial and lateral condyles separated by the intercondylar eminence.

• Medial tibial plateau – larger and stronger
• Lateral tibial plateau – thinner and more prone to fracture
• Intercondylar eminence – attachment of cruciate ligaments
• Menisci attached to plateau margins

The lateral plateau is more frequently injured because it is structurally weaker and more exposed to valgus forces.

The knee joint transmits large axial loads during weight bearing. When excessive force is applied, the femoral condyles may drive into the tibial plateau, producing fracture patterns that depend on the direction and magnitude of the force.

• Valgus forces commonly produce lateral plateau fractures
• Varus forces may produce medial plateau fractures
• Axial compression causes depression fractures
• High-energy trauma may produce bicondylar fractures

• Represents about 1% of all fractures
• More common in men under 50 due to high-energy trauma
• Common in elderly women with osteoporosis
• Lateral plateau fractures are the most common

• Road traffic accidents
• Falls from height
• Sports injuries
• Direct blow to knee
• Low-energy fall in elderly patients

Axial compression combined with valgus or varus forces typically produces characteristic fracture patterns of the tibial plateau.

The Schatzker classification divides tibial plateau fractures into six types based on fracture morphology.

• Severe knee pain
• Swelling and joint effusion
• Inability to bear weight
• Joint instability
• Restricted knee motion

Soft tissue injury, meniscal tears, and ligament injuries frequently accompany tibial plateau fractures.

• AP and lateral knee radiographs
• CT scan for fracture characterization
• MRI for ligament injuries

CT scans are particularly useful for evaluating depression fractures and planning surgical fixation.

• Restore joint congruity
• Maintain limb alignment
• Provide stable fixation
• Allow early knee motion

• Knee stiffness
• Post-traumatic arthritis
• Malalignment
• Compartment syndrome
• Infection

• Lateral plateau fractures are most common
• Schatzker classification widely used
• CT scan essential for surgical planning
• Goal is anatomical restoration of articular surface