07/05/2026
🔺CASE 110: TIBIAL PLATEAU FRACTURE
🔺Female in her mid 30s presented one month after injury with an above-knee cast applied elsewhere.
🔺CT scan showed a severely depressed lateral tibial plateau fracture with a reasonably intact lateral cortex, making the articular depression easy to miss and difficult to access through a conventional fracture window.
🔺Surgical Steps:
• Submeniscal arthrotomy performed for direct visualization of the joint
• A cortical bone flap was carefully raised with a hinge maintained at one end
• Impacted osteochondral fragments were disengaged and elevated anatomically
• Temporary fixation achieved with K-wires
• Void filled with allograft
• Final fixation done using rafting screws and plate fixation to support the reconstructed articular surface
🔺Take-home messages
1. Pure depression type tibial plateau fractures can be deceptive. The cortices may appear intact on plain radiographs, while the joint surface remains significantly collapsed.
2. A CT scan is essential whenever the clinical picture doesn’t match the X-ray findings.
3. Restore the joint surface, support the void, and protect the reduction.
