With joint instability, surgery should be used to address the impacted articular fragments (see the images below). In these fractures, the depressed fragment must be elevated and supplemented with a bone graft. This can be performed either intra-articularly, elevating the anterior horn of the lateral meniscus, or by making a window in the lateral condyle and elevating the fragment with support from graft material and fixation with a buttress plate.
Type II tibial plateau fracture in a young active adult with good bone stock treated with percutaneous elevation and cannulated cancellous screw fixation without bone grafting.
Type II tibial condyle fracture involving the tibial spine and more than 50% of the medial condyle fixed with biological buttress plating of the lateral plateau.
If depression is anterior or central, a straight lateral parapatellar skin incision with transverse submeniscal joint exposure is better. Preservation and repair of the lateral meniscus is the goal. With the use of an impactor from below, the fracture fragments are disimpacted, elevated, and supported with a bone graft. In the case of minimal comminution of the lateral condyle, cancellous screws with washers suffice, whereas a buttress plate is advocated for a comminuted fracture in soft osteoporotic bone.
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Type II tibial plateau fracture in a young active adult with good bone stock treated with percutaneous elevation and cannulated cancellous screw fixation without bone grafting.
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Type III tibial plateau fracture with central depression in an elderly person treated surgically using percutaneous elevation, bone grafting, and cancellous screw fixation.
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Type VI tibial plateau fracture undergoing biological fixation of the lateral condyle and external fixation of the medial plateau, resulting in an acceptable clinical and radiological result.
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Type II tibial condyle fracture involving the tibial spine and more than 50% of the medial condyle fixed with biological buttress plating of the lateral plateau.
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Type VI tibial plateau fracture with severe soft tissue injury successfully treated with Ilizarov external ring fixator.
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High-energy type VI tibial plateau fracture treated with bone grafting and double plating after the soft tissue condition improved.
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Type IV medial tibial condyle fracture treated with arthroscopy-assisted elevation and percutaneous cancellous screw fixation along with percutaneous screw fixation of the tibial spine fracture.
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Shown is an intra-articular fracture of the medial condyle of the tibial plateau.
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Shown is a Schatzker type V fracture, with a displaced and depressed medial tibial plateau.
