Overview
The tibial plateau is the top surface of the tibia that forms the lower half of the knee joint. Plateau fractures often result from a valgus- or varus-directed blow, commonly in pedestrian-versus-car injuries or falls. Joint-surface depression and split patterns are typical.
Surgery is indicated for significant articular depression, split fractures that affect the joint, and bicondylar injuries. Restoration of a smooth, level joint surface is the primary goal because step-offs and residual depression drive post-traumatic arthritis.
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 plateau step-off accelerates cartilage wear.
Displaced split fracture
Widens the plateau and destabilizes the knee.
Bicondylar fracture
Involves both plateaus and is inherently unstable.
Soft-tissue compromise or compartment syndrome
May require staged external fixation first.
Open fracture
Urgent debridement and fixation.
How it works
For simple split fractures, a small incision allows the fragment to be lifted back to its original position and secured with screws and a buttress plate.
For fractures with central joint depression, a cortical window below the joint is used to elevate the depressed cartilage with a bone tamp. The resulting defect is filled with bone graft or bone-graft substitute, and the construct is stabilized with a locking plate. In bicondylar injuries, dual medial and lateral plates may be used.
Recovery
Protected weight-bearing is typical during early healing. Knee range-of-motion exercises begin early, because stiffness is a major concern. Physical therapy is important throughout recovery. Union is confirmed 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. Hardware is left unless it becomes symptomatic.
Contact
For questions about this procedure or to schedule an evaluation, call the office at (830) 625-0009 or request an appointment online.
Weight-Bearing After Repair
Controlled load is part of how bone heals. Once the fracture is stabilized with hardware, gentle weight through the limb stimulates the biology that builds callus and remodels bone — completely offloading 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 construct before 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. The reason we offer this procedure is that the condition, left untreated, causes a malaligned knee joint surface that cannot bear weight evenly and that develops arthritis far earlier than it otherwise would. That is the trade we are managing — not eliminating risk, but choosing the smaller of two unfavorable trajectories.
The risks we discuss with patients before tibial plateau orif include:
- bleeding and infection
- anesthesia risk
- blood clot (DVT/PE)
- 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 articular step-off or knee instability. Patients who don't need this operation don't get it.
Further Reading
External patient-education references and related OSI pages for additional background: