Current treatment of tibial plateau fractures

Treatment of tibial plateau fractures is evolving, and two treatment methods have emerged. One is the use of small incisions and percutaneous stabilization of depression fractures; another is the use of thin wire external fixation for bicondylar fractures. Preoperative planning is aided by classifying fractures as depressed, split, or bicondylar. Depressed fractures can often be treated with insertion of subchondral screws and supporting bone graft under fluoroscopic or arthroscopic guidance. Split fractures are treated with an open approach and application of a buttress plate. Bicondylar fractures require both medial and lateral support to prevent collapse and subsequent varus or valgus deformity. Current treatment of these fractures favors reassembling the articular surface and using thin wire external fixators to align the reconstructed articular block with the diaphysis. Avoiding extensive dissection of comminuted metaphyseal fragments can speed healing, so dissection is generally limited to the region near the tibial articular surface.