Evaluation and Management of Posterior Tibial Plateau Fractures

Tibial plateau fractures are caused by high-energy or low-energy trauma and result in complex injuries that require careful management of both osseous injuries and associated soft tissues. The posterior aspect of the tibial plateau can be involved in a variety of fracture patterns, requiring systematic evaluation, imaging, and advanced surgical planning to address these complex injuries. Early classification systems failed to classify posterior plateau fractures; however, three-dimensional imaging and newer classification schemes, including the Quadrant System and 3D systems, have incorporated posterior column lesions. There has been a growing body of literature focused on fixation principles and plating options for posterior column fractures. Furthermore, there are multiple approaches for surgeons to choose between, including a direct posterior, posteromedial, posterolateral (including Lobenhoffer and lateral condyle osteotomy), and combined posterior approach. This article presents a guide for managing posterior tibial plateau fractures, including the initial evaluation and management, descriptions of the surgical approaches, principles of fixation, and the associated outcomes and complications.