Update: We are now collecting Disclosures from all users who edit content. You will be prompted to update these when you next edit content or you can complete your disclosures at any time in your user profile. This has been reflected in an updated terms-of-use.

Tibial plateau fracture

Last revised by Leonardo Lustosa on 21 Mar 2022

Tibial plateau fractures were originally termed a bumper fracture or fender fracture but only 25% of tibial plateau fractures result from impact with automobile bumpers.

The most common mechanism of injury involves axial loading, e.g. fall from a significant height. In younger patients, the most common pattern of fracture is splitting, while in older, more osteoporotic patients, depression fractures typically are sustained.

Soft tissue injuries (e.g. to cruciate and collateral ligaments) occur in approximately 10% of patients.

Fractures of the lateral plateau are much more common than the medial plateau. To injure the medial plateau, a large amount of force is required; fractures of the medial plateau are usually seen in conjunction with fractures of the lateral plateau and other bones around the knee joint.

The fracture pattern will depend on the mechanism of injury. The Schatzker classification is a useful classification to categorize the mechanism of injury 1:

  • Schatzker I: wedge-shaped lateral plateau fracture
    • valgus force with axial loading (femoral condyle rams the tibial plateau)
  • Schatzker II: wedge-shaped lateral plateau fracture with compression fracture of ipsilateral plateau
    • valgus force (moderate association with medial collateral ligament and medial meniscus injury)
  • Schatzker III: compression fracture of the lateral plateau
    • axial force
  • Schatzker IV: medial plateau fracture with a split or compressed portion
    • varus force with axial load
  • Schatzker V: wedge fracture of both plateaus 
    • complex high energy mechanism involving varus OR valgus forces with significant axial loading
  • Schatzker VI: transverse tibial metadiaphyseal fracture, along with any type of tibial plateau fracture
    • complex high energy mechanism involving varus OR valgus forces with significant axial loading

Tibial plateau fractures are complex injuries that require adequate imaging to assess prior to fixation. 

Plain radiography often underestimates the severity of the injury. Lipohemarthrosis should be present. 

CT is very helpful in accurately defining the extent of the bony injury and facilitates orthopedic intervention. The Schatzker classification is used in tibial plateau fractures.

MRI is very helpful in the assessment of soft tissue injury around the joint.

The goal of therapy is to reduce the fracture and begin early mobilization. If the patient is immobilized for a lengthy period (>3 weeks), the joint will not return to the full range of movement.

Depression of a tibial plateau that is inadequately corrected results in a varus or valgus deformity and accelerated osteoarthritis.

Unappreciated ligamentous injury causes greater than normal stress on the remaining support structures of the joint, malalignment, and the development of premature osteoarthritis.

ADVERTISEMENT: Supporters see fewer/no ads

Cases and figures

  • Figure 1: Schatzker classification
    Drag here to reorder.
  • Case 1: Schatzker type I
    Drag here to reorder.
  • Case 3: Schatzker type II (3D reformat)
    Drag here to reorder.
  • Case 2: Schatzker type II
    Drag here to reorder.
  • Case 4: Schatzker type IV
    Drag here to reorder.
  • Case 6: Schatzker type V (MRI)
    Drag here to reorder.
  • Case 5: Schatzker type V
    Drag here to reorder.
  • Case 8: Schatzker type VI
    Drag here to reorder.
  • Case 7: Schatzker type VI (3D reformat)
    Drag here to reorder.
  • Case 9: lateral tibial plateau fracture
    Drag here to reorder.
  • Case 10: medial tibial plateau fracture (3D reformat)
    Drag here to reorder.
  • Case 11: Schatzker type II tibial plateau fracture
    Drag here to reorder.
  • Case 12: through an amputation stump
    Drag here to reorder.
  • Case 13: Schatzker type V (radiograph)
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.