Tibial plateau fractures (articular fractures of the proximal tibia) most commonly occur in older osteoporotic people or in athletes. The mechanism of injury is a side-loading varus or less commonly valgus force - often combined with axial compression. Varus is more frequent because the other leg protects against a medial force. These were once called "bumper fractures", but are more commonly associated with other mechanisms. They more commonly (approx. 70-80%) occur in the lateral plateau - the medial plateau is stronger. Motor vehicle accidents and falls are the typical events causing this injury in non-athletes.

The Schatzker classification is the commonest descriptive scheme and consists of 6 types. Types I-III are associated with low energy injury and types IV-VI with higher energy. If there is no compromise of joint congruity and stability, non-operative treatment can be attempted. If, however, there is displacement of the fracture fragment, operative fixation should be considered. Other indications for surgery include open fractures, arterial injury and compartment syndrome. Failure to properly treat fractures with joint inconguity and instability can lead to a varus or valgus deformity and early/severe osteoarthritis.

Plain radiography usually is sufficient to diagnose the problem. The finding of a fat/fluid level in a cross table lateral or sunrise view indicates an articular fracture and should inspire a diligent search for a fracture. If the fracture is subtle and/or soft tissue or ligamentous injury is suspected, MR is indicated. Orthopaedic surgeons often favor CT for pre-operative planning and for better characterization of comminuted fractures.

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