What percentage of tibial plateau fractures require surgical intervention?

Surgical Intervention Rates for Tibial Plateau Fractures

Approximately 44% of tibial plateau fractures require surgical intervention, with the remaining 56% being amenable to nonsurgical management. 1

Factors Determining Surgical vs. Conservative Management

The decision between operative and nonoperative treatment depends on several key factors:

• Fracture displacement:

  • Fractures with displacement ≤4mm can be successfully treated nonoperatively with similar functional outcomes to surgery 2
  • Fractures with displacement >4mm typically require surgical intervention to restore articular congruity 3

• Fracture classification:

  • Schatzker classification guides treatment decisions, with Schatzker II fractures being the most common (48% of cases) 3
  • More complex fracture patterns generally require surgical fixation 4

• Articular depression:

  • Depression >4mm at time of union is associated with significantly higher risk of progression to total knee arthroplasty (HR = 16.2) 3
  • Anatomic reduction is critical for long-term outcomes 1

Outcomes Based on Treatment Approach

Nonoperative Treatment

• Appropriate for minimally displaced fractures (≤4mm displacement) 2
• Associated with fewer complications (0% vs. 4% in surgical cases) 2
• Lower reoperation rates (6% vs. 39% in surgical cases) 2
• Similar patient-reported outcomes compared to surgery for minimally displaced fractures 2

Surgical Treatment

• Indicated for:
  • Displaced fractures (>4mm) 3
  • Unstable fracture patterns 4
  • Fractures with significant articular incongruity 1
• Surgical approaches include:
  • Open reduction and internal fixation (ORIF) 3
  • Arthroscopy-assisted surgery (89% satisfactory results) 5
  • Various fixation methods (screws, plates) based on fracture pattern 5

Long-Term Outcomes and Complications

• Total knee arthroplasty conversion:

  • 9.3% of surgically treated tibial plateau fractures require TKA within 10 years 3
  • 10-year survivorship (without TKA) is 87.4% 3

• Risk factors for poor outcomes:

  • Articular depression >4mm at union (HR = 16.2 for TKA) 3
  • Increased tibial width at union (femoral width ratio >1.05, HR = 14.7 for TKA) 3
  • Age >50 years (HR = 4.2 for TKA) 3

• Complication rates:

  • Nonoperative treatment: 8% complication rate 1
  • Operative treatment: 19% complication rate, with infection being a significant concern 1

Clinical Implications

• CT imaging is superior to radiographs for accurate assessment of tibial plateau fractures, with 100% vs. 83% sensitivity respectively 6
• MRI is valuable for evaluating associated soft tissue injuries when tibial plateau fractures are identified 6
• Early mobilization and rehabilitation are important regardless of treatment approach 1
• Anatomic reduction of the articular surface is a major factor in successful management 1

In conclusion, while 44% of tibial plateau fractures require surgical intervention, treatment decisions should be based on fracture displacement, pattern, and patient factors, with minimally displaced fractures (≤4mm) generally being appropriate for nonoperative management.