Overview
The tibial plateau is the flat top surface of the tibia (tibia) that forms the lower half of the knee joint. It is where the rounded ends of the femur (femur) sit and roll during knee motion, and it is covered with articular cartilage (the smooth, slick surface tissue that lets joints move without friction). Plateau fractures break this surface, and they typically result from high-energy forces directed into the knee, such as a side-impact blow (commonly in pedestrian-versus-vehicle collisions), a fall from height, or a skiing injury. The fracture pattern depends on which direction the force came from and how much energy was involved.
There are several types. A split fracture means a wedge of bone has cleaved off from the outer or inner edge of the plateau. A depression fracture means the joint surface has been driven downward (like a dent). Many tibial plateau fractures combine both. Bicondylar fractures involve both the inner (medial) and outer (lateral) sides of the plateau and are more severe, often caused by axial loading (force driving straight down through the leg).
The critical concern with any tibial plateau fracture is the condition of the joint surface. A step-off or depression in the cartilage creates uneven load distribution across the knee with every step you take, and even small irregularities accelerate cartilage wear, ultimately leading to post-traumatic arthritis (joint degeneration caused by injury rather than age). The goal of surgery is to restore the plateau to a smooth, level surface and hold it there while the bone heals.
Not all tibial plateau fractures require surgery. Fractures that are non-displaced (the bone fragments have not shifted from their normal position) and stable may heal with protected weight-bearing in a brace. The decision is made based on the fracture pattern seen on CT scan (which gives much better detail than X-ray alone), the degree of displacement, and your activity level and overall health.
Why it's done
Tibial plateau ORIF is typically considered when imaging and the clinical picture together indicate that the fracture will not reliably heal or function without surgical stabilization. Common indications include:
Depressed articular fragment
A step in the joint surface accelerates cartilage wear.
Displaced split fracture
Widens the plateau and destabilizes the knee.
Bicondylar fracture
Involves both sides of the plateau and is inherently unstable.
Soft-tissue compromise or compartment syndrome
When swelling causes dangerous pressure buildup in the leg, we may apply a temporary external frame first to hold the bone until the soft tissues are safe enough for definitive fixation.
Open fracture
Urgent wound cleaning and fixation.
How it works
For simple split fractures, we work through a small incision, lift the fragment back to its original position, and secure it with screws and a buttress plate (a plate positioned to prop the fragment up so it cannot slide back down).
For fractures with central joint depression, we make a small window in the bone just below the joint surface to access the sunken cartilage from underneath and push it back up into position. The cavity left behind is packed with bone graft or a bone-graft substitute, and a plate locks everything in place. Fractures involving both sides of the plateau may require plates on the inner and outer sides.
Recovery
You will be on partial or no weight-bearing during early healing; the timeline depends on the fracture pattern. Knee range-of-motion exercises begin early because stiffness is a major concern after these injuries. Physical therapy is important throughout recovery. We confirm healing on X-ray at follow-up visits. Post-traumatic arthritis is a known long-term risk; total knee replacement may become an option later if symptoms develop. The hardware stays in unless it causes a specific problem.
Contact
For questions about this procedure or to schedule an evaluation, call the office at (830) 625-0009 or schedule an appointment online.
Physicians Who Perform Tibial Plateau ORIF
Weight-Bearing After Repair
Controlled load is part of how bone heals. Once the fracture is stabilized with hardware, gentle weight through the limb helps the bone heal, while keeping all weight off a fixed fracture for too long can actually slow healing and stiffen the joint above and below. Full body weight right away, however, can overload the repair before the bone has caught up. The right answer sits in between: a partial weight-bearing progression decided by your surgeon based on your fracture pattern, the strength of the fixation, your bone quality, and how the repair looks on post-op imaging. We tell you exactly how much weight the limb can take, when to advance, and what to watch for.
Risks & Why We Still Recommend It
Every operation carries risk. This procedure is offered because the condition, when left untreated, can cause a misaligned knee joint surface that cannot bear weight evenly and develops arthritis far earlier than it otherwise would. The decision to proceed weighs the risks of surgery against the limitations the condition places on daily function. Surgery does not remove risk; it addresses a problem that is otherwise progressive. Whether it is appropriate is determined for each patient in consultation with the surgeon.
The risks we discuss with you before tibial plateau fracture fixation include:
- bleeding and infection
- anesthesia risk
- blood clot in the leg or lung
- stiffness
- loss of reduction or articular depression recurring
- compartment syndrome in the setting of high-energy patterns
- hardware irritation
- post-traumatic arthritis over time
The indication to proceed is a displaced or depressed tibial plateau fracture with a step in the joint surface or knee instability. If this operation is not right for you, we will not recommend it.
Frequently Asked
questions we hear in clinicDoes every tibial plateau fracture need surgery?
No. Fractures that are non-displaced and stable may heal with protected weight-bearing in a brace. The decision is made based on the fracture pattern seen on CT scan, which gives much better detail than X-ray alone, the degree of displacement, and your activity level and overall health.
Why does a small step in the joint surface matter?
A step-off or depression in the cartilage creates uneven load distribution across the knee with every step you take, and even small irregularities accelerate cartilage wear, ultimately leading to post-traumatic arthritis. The goal of surgery is to restore the plateau to a smooth, level surface and hold it there while the bone heals.
How is a sunken joint surface fixed?
We make a small window in the bone just below the joint surface, push the sunken cartilage back up into position from underneath, pack the cavity left behind with bone graft or a bone-graft substitute, and lock everything in place with a plate.
When can I put weight on the leg?
You will be on partial or no weight-bearing during early healing; the timeline depends on the fracture pattern. Your surgeon sets a partial weight-bearing progression based on your fracture pattern, the strength of the fixation, your bone quality, and how the repair looks on post-op imaging.
Will I get arthritis in the knee later?
Post-traumatic arthritis is a known long-term risk after these injuries. If symptoms develop, total knee replacement may become an option later.
Does the hardware come out?
The hardware stays in unless it causes a specific problem.
Further Reading
External patient-education references and related OSI pages for additional background: