Does a tibial plateau fracture always need surgery?

When a brace may be enough

Non-surgical treatment is usually considered when the CT scan shows the joint surface is close to its normal level, the fragments have not separated, and the knee is stable when tested in near-full straightening. It is also sometimes chosen for patients with health problems that make surgery high risk.

Treatment involves a hinged brace, crutches with no or only light weight on the leg for several weeks, early gentle bending, and regular X-rays to check the fracture is not settling.

When surgery is usually advised

• A step or depression in the joint surface beyond a small amount
• Widening of the plateau or separated fragments
• Instability of the knee from side to side
• Fractures involving both sides of the plateau or the shaft below
• Open fractures, compartment syndrome or an associated artery injury
• Combined ligament or meniscus injuries that need repair

What the operation involves

The most common operation is open reduction and internal fixation. The depressed joint surface is lifted back to level, often supported underneath with bone graft or bone substitute, and held with plates and screws. Some fractures can be fixed with screws through small incisions, sometimes with an arthroscope to check the joint surface and treat a torn meniscus.

After high-energy injuries with severe swelling, surgeons often apply a temporary external frame first and wait for the skin to settle before the definitive fixation, because operating through swollen skin raises the risk of wound problems.

A considered plan in Doha

The aim is a stable, well-aligned knee with a joint surface as smooth as possible. At Aman Hospital, Dr. Gelber goes through the CT images with you, explains the options, and plans how fixation and rehabilitation fit with your work and family responsibilities. If you were first treated elsewhere, a review of your scans is also possible.