Surgical Treatment of Posterior Tibial Plateau Fractures

Posterior tibial plateau fractures are not uncommon injuries and often necessitate surgical treatment. They are frequently unstable with knee flexion even in the absence of an axial load. As with other tibial plateau fractures, knee instability and articular incongruity are indications for surgery. Optimal reduction and fixation usually requires a direct surgical approach, which is dictated by the fracture location and morphology. Common fracture morphologies include a posteromedial fragment that may or may not be associated with a bicondylar tibial plateau fracture, a posterior shearing pattern that involve the posteromedial and posterolateral plateaus, and a fracture that is with posterolateral articular impaction. This article provides an overview of current concepts in the surgical treatment of posterior tibial plateau fractures with discussion on relevant surgical approaches and fixation strategies. Although the overall incidence of these injuries is relatively low, it is important for surgeons to recognize these injury patterns and treat them appropriately to optimize patient outcome.