Tibial Plateau Fractures: A Systematic Review of Diagnostic Approaches, Surgical Strategies, And Functional Outcomes

Abstract

Heytor Mendes Camargo Costa, Luiz Fernando Sari Sampaio, Arthur Rodrigues de Almeida Aguiar, Amanda Caroline da Silva Morais, Paulo Henrique Cardoso Amorim, Lucas Tomaz Valim, Sergio Gabriell de Oliveira Moura and Fernanda Grazielle da Silva Azevedo Nora*

Introduction: Tibial plateau fractures (TPFs) represent complex articular injuries that require precise diagnostic evaluation and individualized therapeutic strategies to prevent long-term joint dysfunction. Despite advancements in surgical techniques and imaging modalities, there is still considerable variability in clinical outcomes and a lack of consensus on optimal management protocols.

Objective: To systematically review and synthesize the current literature on the diagnostic approaches, classification systems, surgical techniques, and functional outcomes associated with tibial plateau fractures, aiming to provide an evidence-based foundation for clinical decision-making.

Methods: This systematic review was conducted in accordance with PRISMA guidelines. A comprehensive literature search was performed in PubMed, MEDLINE, ScienceDirect, and Google Scholar from January 2010 to March 2025. Only openaccess, English-language original studies involving human subjects were included. Articles were screened based on predefined inclusion and exclusion criteria, and 35 studies were selected for qualitative synthesis. Data were extracted regarding imaging techniques, fracture classifications, operative management, postoperative rehabilitation, and complications.

Results: The review revealed a shift toward the use of CT-based and three-column classification systems for better preoperative planning and outcome prediction. Open reduction and internal fixation (ORIF), minimally invasive plate osteosynthesis (MIPO), and hybrid techniques remain the primary surgical approaches. Functional recovery was positively associated with early mobilization protocols and individualized rehabilitation strategies. However, complications such as post-traumatic osteoarthritis, malalignment, and infection were still prevalent, particularly in high-energy and bicondylar fractures.

Conclusion: Accurate diagnosis and classification of TPFs are critical for guiding surgical intervention and optimizing long-term function. Although modern imaging and operative innovations have improved outcomes, complication rates remain a challenge. A multimodal approach that integrates advanced diagnostics, tailored fixation strategies, and structured rehabilitation is essential for improving patient prognosis

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