If the depression is small and the joint remains stable, nonoperative treatment is preferred in elderly persons. However, if the joint is unstable in a physiologically younger patient, surgery is usually indicated. The depressed fracture can be visualized with arthroscopy or under a C-arm. A window is made in the metaphyseal region, the depressed articular surface is elevated, and the subarticular portion is supported with a graft and then supported with one or two cannulated screws or with a plate (see the image below).
Type III tibial plateau fracture with central depression in an elderly person treated surgically using percutaneous elevation, bone grafting, and cancellous screw fixation.
Formal open reduction and plate fixation for Schatzker type I-III fractures is an alternative to arthroscopically assisted reduction and fixation. [26] Direct visualization of the reduction of the joint surface can be obtained via a submeniscal arthrotomy or by detaching the anterior horn of the lateral meniscus using a lateral approach.
In cases with wide displacement, associated fibular head fracture, and osteoporotic bone, buttressing with a plate provides better fixation than screws alone and may decrease the risk of collapse of the elevated fragments. If one is in doubt, buttressing should be used.
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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.
