Tibial Plateau Fractures

Major changes have been undertaken in the management of the tibial plateau fractures since the introduction of the AO principles. Such principles have not just determined the importance of anatomical reduction of the articular surface, but also stable fracture fixation allowing for early motion. The surgical treatment, when indicated, is performed in a single or staged fashion, depending on the status of the soft tissues. Three-dimensional imaging added understanding to the fracture patterns, promoting the development of new classification templates, and algorithms of treatment. Kfuri and Schatzker have revisited the principles of the tibial plateau fracture classification and the definitive management of those injuries raising the attention to the importance of the split wedge fragment as the key element for joint instability. Congruity and stability should be pursued in the management of tibial plateau fractures, but in case congruity is not achievable due to severe comminution of the articular surface, restoring the tibial plateau rim continuity, and providing containment to the proximal tibia, should be the aim. Joint stability and alignment are critical for early function.