Fracture of the tibial plateau occurs as a result of strong valgus or varus forces combined with axial loading. These occur with falls, sports injuries, and motor vehicle accidents. The typical “bumper” fracture occurs when the bumper of a car hits the lateral side of the knee. A valgus load is applied to the knee, and the lateral femoral condyle loads the lateral plateau, creating a fracture.

The patient presents with pain and swelling of the knee and is unable to bear weight on the affected extremity. On physical examination, the patient has limited range of motion. A complete neurovascular assessment is done by checking distal pedal pulses and the function of the peroneal and tibial nerves of the involved extremity. The compartments of the leg should also be examined to rule out compartment syndrome. This is done by checking the tension of the skin, eliciting pain with passive extension of the big toe, and noting decreased light touch sensation in the first web space. If compartment syndrome is suspected, an orthopedic consultation is mandatory.

Anteroposterior (AP)/lateral and a 20-degree caudal tilt AP x-ray are helpful. Fractures are classified according to where the fracture line extends (Fig. 1). In the past, treatment guidelines were based solely on x-ray; now, computed tomography scans are also used to assess articular depression and comminution.

The involved extremity is immobilized in a long posterior splint or immobilizer. All lacerations are cleaned and dressed. The extremity is elevated and iced. All displaced fractures of the tibial plateau require an orthopedic consultation for definitive care.