At the peak: a review of current diagnostic and therapeutic concepts surrounding tibial plateau fractures

Abstract

Tibial plateau fractures are complex injuries commonly resulting from high-energy trauma in younger patients or low-energy falls in the elderly. They significantly impair knee function and overall quality of life, often leading to complications such as post-traumatic osteoarthritis and knee stiffness. This review looks at current diagnostic modalities, epidemiological data, anatomical considerations, and therapeutic strategies for managing tibial plateau fractures, highlighting advancements in treatment and outcomes. The well-established Schatzker and AO/OTA systems of classification have evolved alongside emerging frameworks like the three-column classification and ten-segment concepts that utilize three-dimensional imaging technologies. Tibial plateau fractures have an estimated incidence of 10.3 per 100,000 people, with males affected more frequently than females. The incidence increases with age, particularly among women in their seventh decade. The management of tibial plateau fractures can involve either non-operative or operative interventions. While minimally displaced fractures may be treated conservatively, more complex cases typically require surgical procedures such as open reduction and internal fixation or arthroscopically assisted techniques. Recent improvements in rehabilitation protocols and surgical techniques aim to enhance recovery and minimize complications. Long-term assessments indicate that functional deficits and complications persist in many patients following tibial plateau fractures. Factors such as age, fracture type, and soft tissue integrity significantly influence recovery trajectories. Effective management of tibial plateau fractures requires a multi-faceted approach that utilizes imaging techniques, judicious surgical intervention, and patient-tailored rehabilitation. Further research is needed to refine treatment protocols and establish standardized methods for evaluating functional outcomes.