A tibial plateau fracture is a break at the top of the tibia bone in the shin, which is often due to high energy trauma.

The tibia, also known as the shin bone, is the main bone in the lower leg. The tibial plateau describes the relatively flat, smooth area at the top of the bone that connects to the femur — the thigh bone — to create the knee.

Cartilage covers the tibial plateau, providing a cushion and frictionless surface for the knee joint to bend and move.

A person can fracture, or break, their tibial plateau, resulting in pain, swelling, and, in severe cases, loss of mobility of the knee joint. A break in this bone is often associated with high impact trauma, such as a fall from a ladder or car accident.

This article reviews what a tibial plateau fracture is, its causes, symptoms, and treatment.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

A person lying on the bed recovering from a fractured tibial plateau.Share on Pinterest
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The tibial plateau consists of the top part of the tibia and cartilage. Along with the bottom of the femur, it helps to create the knee joint.

A tibial plateau fracture is a minor to severe breakage of the top part of the tibia along with the cartilage that make up the bottom portion of the knee. Mild breaks may be a single crack, while severe cases can involve shattering the entire area that makes up the plateau.

The majority of tibial plateau fractures occur due to high energy or impact injury to the area. Possible causes can result from activities and situations such as:

  • falling from a height such as a ladder
  • being in a car or automobile accident
  • falling off a horse while riding
  • experiencing a sporting injury, such as downhill skiing, combat sports, or a direct hit playing football

According to a 2022 paper, the median age of the injury is about 52 years old. The causes can vary based on age and gender. In males younger than 50, the common cause is traumatic injury. In females over 70, the most common cause is a fall. Males have a higher chance of having a tibial plateau fracture than females.

A person who has a tibial plateau fracture will typically experience pain in the lower part of their knee. Other symptoms can include:

  • edema, swelling or inflammation of the knee
  • loss of range of motion
  • reduced strength or stability in the knee

When a person fractures their tibial plateau, it can cause bleeding or swelling in all of the compartments of the lower leg. When this occurs, the inflammation can put pressure on the muscles, nerves, and blood vessels.

This is known as compartment syndrome. Compartment syndrome can be acute or chronic, but it is likely acute when it occurs due to a tibia plateau fracture.

The swelling causes decreased blood flow to the muscles and nerves, which can cause permanent damage to the muscles or nerves.

A person who develops compartment syndrome will need emergency surgery to prevent permanent damage, such as loss of limb.

Doctors often use the Schatzker classifications system in North America. It is a system that describes the location and severity of a tibial plateau fracture. It comprises several levels, including:

  • Schatzker Type I: A wedge-shaped fracture with minimal depression that often occurs in younger people.
  • Schatzker Type II: Split, wedge-shaped fracture combined with a deeper depression in the bone, often in people with osteoporosis or low bone quality.
  • Schatzker Type III. Depression in the lateral tibial plateau without a wedge or other fracture, most often in people with osteoporosis.
  • Schatzker Type IV: Medial fracture of the tibial plateau with a split or depression often associated with damage to soft tissue, which can occur in both osteoporosis and traumatic injury cases.
  • Schatzker Type V: Wedge fracture of lateral and medial tibial plateau often with lateral depression, usually resulting from high energy trauma.
  • Schatzker Type VI: Transverse fracture with a dissociation between the midsection of the bone and the narrow portion with many open and associated with soft tissue damage.

While helpful in classifying many tibial plateaus, it does not describe about 10% of all cases. It most often cannot address fractures associated with dislocation or knee instability.

Treatment will vary based on the severity of the fracture. Minimal fractures require the least amount of interventions that may include:

  • use of pain relief medications
  • ice and rest
  • use of splints or other means to stabilize the knee

In more severe cases, a doctor will likely recommend surgical intervention.

Surgery may help restore function and range of motion in the knee. Surgical options may involve plates, bone cement, or pins to help fix the break.

Recovery time also varies based on the severity of the injury and the required intervention. In general, the best outcomes occur with less severe trauma. High energy impacts can affect range of motion, stability, and overall movement.

A tibial plateau fracture occurs in the top portion of the tibia, where it forms the knee joint.

The break may be due to a fall or traumatic injuries, such as sports or a car accident. Less severe injuries tend to lead to better outcomes and results.