Tibial Plateau Fractures: A Narrative Literature Review

Abstract

Aims: To provide an updated narrative review of tibial plateau fractures, including clinically relevant anatomy, biomechanics, epidemiology, classification, radiographic assessment, acute management, fixation strategies, rehabilitation, prognosis, complications, limitations of current evidence, and future directions. Study Design: Narrative literature review. Methodology: A narrative literature search was performed using PubMed, Google Scholar, and major orthopaedic reference sources for publications relevant to tibial plateau fractures. Search terms included tibial plateau fracture, Schatzker classification, three-column classification, posterolateral tibial plateau fracture, computed tomography, soft-tissue injury, surgical approach, fixation, conservative treatment, rehabilitation, prognosis, and post-traumatic osteoarthritis. English-language articles, reviews, clinical studies, book chapters, and imaging-based studies published mainly from 2007 to 2025 were considered, with emphasis on recent literature from 2023-2025 and landmark references needed to explain classification and treatment principles. Results and Discussion: Tibial plateau fractures are complex intra-articular injuries of the proximal tibia that may result from low- or high-energy trauma. They account for approximately 1% of all fractures, and recent epidemiological studies continue to show variation according to age, trauma mechanism, bone density, and local injury patterns.1-6 Fracture morphology is influenced by knee position, axial load, varus-valgus force, bone quality, cartilage support, and subchondral bone strength. Schatzker, AO/OTA, and three-column classification systems provide complementary information for describing fracture morphology and selecting surgical approaches. Standard radiographs remain the first-line imaging method, but computed tomography is essential for complex fractures and for identifying posterior-column fragments. Management should be individualized according to fracture displacement, soft-tissue condition, associated meniscal or ligament injury, neurovascular status, compartment syndrome, and patient-related factors. Conclusion: Tibial plateau fractures require structured evaluation of fracture morphology, soft-tissue condition, limb alignment, articular congruity, and patient factors. Conservative treatment is appropriate for selected stable fractures, whereas surgery is indicated for displaced, unstable, open, bicondylar, or soft-tissue-complicated injuries. Current evidence supports CT-guided planning, careful soft-tissue management, column-specific fixation when required, early controlled motion, and individualised rehabilitation, with the aim of reducing the risk of stiffness, malunion, non-union, neurovascular injury, compartment syndrome, and post-traumatic osteoarthritis.