Video transcript

Let’s go over what a tibial plateau fracture is — and what to expect during recovery.

​

The tibia is the larger of the two bones in your lower leg. It connects the knee to the ankle, and it carries most of your bodyweight. The upper part of this bone is covered in a smooth cartilage layer, where it forms the surface of your knee joint. This area is called the tibial plateau.

A fracture of the tibial plateau means that you have a break in this area, which is likely to be affecting the knee joint to some degree. This type of injury can happen from a fall, a twisting injury, or a direct impact.

Some tibial plateau fractures are relatively minor, while others can be more serious. Important factors that go into this equation are how significantly the injury affects the smooth joint surface of the knee — and how unstable the fracture is likely to be.

After being seen in the emergency department, you should have your knee immobilised and you will have been given advice regarding any limitations to your weightbearing. After this initial treatment, you will be seen in our fracture clinic within one to two weeks. Here, we will often get further X-rays to confirm the position of your fracture and the knee joint. While most cases seen in the fracture clinic will be appropriate to continue with non-operative management, avoiding the need for surgery — your surgeon will need to review your X-rays to ensure this remains an appropriate strategy. In some cases, especially if your fracture appears to change position within the first few weeks, surgery may be considered to restore a smooth joint surface and stabilise the bone. This decision would also depend on your lifestyle, functional levels, and medical background.

​

For the majority of tibial plateau fractures seen in fracture clinic, non-operative management is appropriate. Your orthopaedic surgeon will make a plan for your healing period, which often involves restricting your movement and weightbearing for the first six to eight weeks. In most cases, a removable hinged knee brace can be used. However, a cast may be required depending on the characteristics of your fracture.

The length of time you need to protect the knee will vary based on your exact injury. For the first six weeks, the focus is on protecting the fracture and avoiding any movement that might cause the joint surface to move out of position.

Once early healing has taken place, you’ll usually begin a gradual return to movement and activity. As your leg muscles will have deconditioned after a period of immobilisation, physiotherapy is often available to help you regain strength, movement and control of the leg. As you get stronger and the bone heals further, your team will guide you on when to start putting weight back through the leg and weaning off any support. Your engagement with physiotherapy plays a large part in your outcomes, and performing regular self-directed exercise is the main factor in getting you back towards normal function.

Once you return to light activities, minor discomfort and swelling are common for a few months, especially after knee-heavy activities. This settles with time, as the bone continues to heal and the knee adjusts to movement again. If you experience any new locking, instability or persistent problems in your functional recovery, you can contact the fracture clinic to review your progress and check for any issues.