Management of Unicondylar Tibial Plateau Fractures: A Review

Daniel Warren, BS; Grayson Domingue, MD; John T. Riehl, MD


Curr Orthop Pract. 2022;33(1):85-93. 

In This Article

Abstract and Introduction


Unicondylar tibial plateau fracture (TPF) is a common orthopaedic injury. Although some are treated nonsurgically with excellent results, many are treated operatively to achieve improved patient outcomes. Commonly utilized surgical treatment options include open reduction internal fixation (ORIF) and percutaneous treatment which may include arthroscopic reduction internal fixation (ARIF). The most used classification remains the Schatzker fracture classification. This article presents a review of the epidemiology, relevant anatomy, biomechanics, clinical presentation, diagnosis, and management of tibial plateau fractures.


Unicondylar tibial plateau fractures (TPF) are fractures typically seen in adults ages 40 to 60 yr, with a mean age of 52.6.[1] A large, population-based study demonstrated the incidence of all TPFs to be 10.3 per 100,000 annually, with 59.7% of the total being partial articular fractures (AO Foundation/Orthopaedic Trauma Association [AO/OTA] type 41B).[1] Fracture incidence was higher in men younger than 50 yr and was elevated markedly in women older than 50 yr.[1] The difference in incidence among men and women, which specifically increases among postmenopausal women, suggests that bone mineral density (BMD) can play a significant role in the incidence of TPFs.[1–3]

There is typically a bimodal incidence of TPF. In younger populations TPFs often present after high-energy events such as falls from a height, automobile and motorcycle accidents, or pedestrian versus automobile accidents, whereas TPFs in older populations occur from low-energy events such as fragility fractures.[4] Understanding the mechanism of injury in the context of the different compositions of the medial and lateral tibial plateau is helpful in the evaluation of TPFs. The medial plateau has a relatively greater BMD than the lateral plateau and is classically a high-energy fracture among younger patients.[1] However, in a postmenopausal woman, an isolated medial plateau fracture can be a result of a low-energy event. In this setting, this fracture can be considered a fragility fracture that requires further evaluation for osteoporosis.[2]

Understanding the tibial plateau and management of the various patterns of injury has important implications for clinical practice. There are diverse patterns of injury, classifications, treatment options, and an array of potential complications that exist in dealing with this group of pathologies. Furthermore, there are often multiple treatment algorithms that can be applied in their management with none demonstrating clearly superior results.[5–7] A thorough knowledge of the best available evidence will allow the orthopaedic practitioner to develop effective treatment strategies for these challenging and technically demanding injuries.