What is a Tibial Plateau Fracture?

Broken Top of the Shin Bone Involving the Knee Joint

Tibial Plateau Fracture. Image © Jonathan Cluett, M.D.

A tibial plateau fracture occurs at the top of the shin bone, and involves the cartilage surface of the knee joint. Because these fractures occur around the knee joint, they must be treated differently than the tibial shaft fractures discussed previously.

When a fracture occurs into or around a joint surface, that joint is at high risk of developing arthritis due to the injury. Unfortunately, even if the bone and cartilage surfaces are lined up perfectly, there is still a risk of developing knee arthritis due to injury to the cartilage cells.

Treatment of Tibial Plateau Fractures

Treatment of tibial plateau fractures depends most importantly on how well aligned the knee joint cartilage is.  In patients without displacement of the fracture or the cartilage, there is a role for non surgical management.  In situations where the bone or cartilage is not well aligned, surgical treatment is more often considered.

In addition to fracture alignment, another major condition that helps determine treatment is the condition of the soft-tissues around the fracture.  Surgery is almost always performed when there is an open fracture (bone penetrating the skin), whereas severe swelling may be a reason to delay surgery in fractures where the skin is in tact but the soft-tissues are severely damaged.

Non-Displaced Tibial Plateau Fractures
Non-displaced fractures are cracks in the bone seen on x-ray, but with the bones remaining in their proper position and alignment.

Most non-displaced fractures of the tibial plateau can be treated without surgery, but they usually require an extended period (up to 3 months) of protection from walking.

Some non-displaced fractures are at risk for displacing (shifting position) in the days and weeks following injury, and therefore these injuries must be closely watched by your orthopedic surgeon.

If displacement occurs, surgery may be needed to realign the bone fragments and hold them in position.

Displaced Tibial Plateau Fractures
Displaced fractures often require surgery to realign the bones and restore stability and alignment of the knee joint. There are several surgical options in the treatment of tibial plateau fractures; choosing the type of procedure depends on the fracture pattern--certain types of fractures may or may not be amenable to treatment with a particular type of surgery.

Surgical treatments usually involve the placement of screws and plates into the fractured bone. If the bones are lined up well, this procedure may be treated with small incisions using x-ray to line up the bones. If there is more displacement of the fragments of bone, a larger incision will be needed to piece together the fragments.

To hold the bone fragments in place, either screws alone, or plates and screws can be used. Screws alone are usually used when one piece of bone has broken off, and can be easily repositioned.

If the tibial plateau fracture requires additional support, a plate will be placed along the bone to help support the fragments while healing takes place.

Rehab from Plateau Fractures

Recovery from a tibial plateau fracture can take several months. Because the cartilage surface of the joint is involved, the knee must be protected from weight until the fracture has healed. Most commonly patients will be allowed to move the knee joint, but not put weight on the leg for about three months. The exact length of time of limitations will vary on the fracture type and the amount of healing that takes place.


Koval KJ & Helfet DL. "Tibial Plateau Fractures: Evaluation and Treatment" J Am Acad Orthop Surg March 1995 ; 3:86-94.

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