Have just fractured your tibial plateau knee and wondering how long the recovery and healing timeline is going to last.
Or about the treatment options and what you can do to maximise your chances of recovering quickly and well.
In this article I will answer your questions based on my knowledge as a diagnostic radiographer and on available data in the medical scientific literature on the subject.
Happy reading!😃
Any questions do not hesitate to leave in the comments sections.
Last updated: April, 2025. Written by Juliet Semakula, a diagnostic radiographer.
▶️Basic anatomy
The tibial plateau is the bony articular surface of the proximal tibia that forms the distal half of the knee joint.
It consists of a medial and lateral condyle separated by the intercondylar eminence.
X-ray Image showing an AP and Lateral views of a normal tibial plateau of the knee.
▶️What are the different types of Tibial plateau fracture classification
Tibial plateau fractures are peri-articular knee fractures of the proximal tibia.
The presentation of tibial plateau fractures can vary greatly based on the mechanism of injury.
The Schatzker classification (Figure below) is commonly used to describe tibial plateau fractures
🟤Type I fracture is a pure split of the lateral plateau
🟤Type II fractures: combines type I and depression of the remaining lateral plateau
🟤Type II fractures (a sagittal split in the lateral plateau with depression of the joint line) are most associated with soft tissue injuries
🟤Type III fractures (a pure depression of the joint line in the lateral plateau) are typically seen in older patients.
Type VI fractures (complex plateau fractures with a transverse sub-condylar fracture)
🟤Type V fracture combines both the lateral and medial plateau with metaphysis, and it may include fracturing the intercondylar eminence.
🟤Type VI fracture is the dissociation of the metaphysis from the diaphysis with a varying degree of communication between the condyles and the articular surface.
Schematic illustration of the Schatzker classification of tibial plateau fractures: image from Rudran,2020
X-ray is often enough to determine the type of fracture, although some teams prefer to use a CT or MRI scan.
Whatever type of fracture you may have, does not change management of these kinds of fractures.
▶️How serious is a tibial plateau fracture? Possible complications.
The traumatic event resulting in a tibial plateau fracture usually can cause other complications to the knee.
Here are some of the possible complications before and after treatment.
🟢Injure to the surrounding soft tissue structures.
🟢The lateral menisci may tear.
🟢Avulsions or partial tears of the anterior cruciate ligament.
Rudran,2020
🟢Multiple surgical complications such as wound complications and infection.
🟢Bleeding and metalwork problems can increase the burden of poor healing outcomes
🟢Later development of arthritis, muscle, bone atrophy and joint stiffness.
Iliopoulos,2020
▶️What is the treatment for tibial plateau fractures?
Most plateau tibial fractures I have seen in x-ray, have been managed by surgery.
Treatment of these fractures may be complicated by osteoporosis, osteoarthritis, and medical comorbidities.
Conservative management may only be used if:
♦️The fracture is nondisplaced such as type I fractures
♦️️ If you have poor mobility, functional demands such as the elderly.
♦️You have severe osteoarthritis of whom joint replacement arthroplasty is preferred.
♦️You have acute illnesses that preclude any surgical intervention.
If your doctor decides for you to have a conservative management, then you may be prescribed and given some instructions.
Your medical team will know what is best for your case because they should have viewed your x-rays, know your overall health and medical history.
🟢You may be given a hinged knee brace to protect the injured knee with a tolerated range of motion.
🟢For noncompliant patients, a long leg cast with slight knee flexion may replace the brace, but frequent skin checks are required.
🟢You may be prescribed physiotherapy to help with continuous passive motion using machines to facilitate motion.
🟢You will be restricted to weight-bear on the affected leg.
Surgical treatment
Most tibial fracture surgery I have seen is done within hours or at most days following the fracture. The goal is
🟢To stabilise the fracture
🟢And maximise the chances that your bone will heal well to limit the risk of complications.
X-rays images showing surgery of a broken tibial plateaus (Luo,2010)
After your operation your medical team who will be following you will provide you with more detailed information on how to weight bear and look after the wound.
In some patients, hardware may be removed, here is a hardware removal article which explains why some hardware is removed and others not.
You will be prescribed compression socks to help reduce the risk of blood clots which occur very rarely in any case.
▶️What is the recovery time for a tibial plateau fracture?
Several factors will determine your healing time
🟡Your general condition before the fracture.
🟡Associated injuries such as ligament, and soft tissue injuries
🟡How severe your tibia fracture is, usually with these kinds of fractures have multiple bone fragments.
So, it is very difficult if not impossible to give you a precise prognosis for your recovery.
The table below summarises the different stages of recovery and healing with or without surgery. Based on medical studies and people who have had these types of fractures.
| Phase | Timeframe from day of fracture |
| Less pain | With in a few hours to a few days |
| Bones well healed | 6 weeks to 3 months |
| Knee swelling disappears | Within a few weeks to a few months |
| Full weight bearing can be instituted at | 8 to 12 weeks after the injury (Rozell 2016) walking without crutches 2 to 6 months. |
| Walking with crutches | Immediately |
| Driving a car | 2 to 6 months |
| Returning to work | Varies depending on your activity |
| Returning to sports | Will vary depending on the sport, between 4 to 18 months on average 7 months (Robertson 2017) |
| Full functional and muscular recovery | 4 months to 1 and half years |
Typical healing and recovery time after tibial plateau fracture
▶️What are long term effects after a tibial plateau fractures?
The good news is it is highly likely that you will fully recover from a tibial plateau fracture. After a few months you should not have any complications
Most people return to their normal activities such as sports and other activities if they were doing it before.
70% of people return to sports on average 7 months (Robertson,2017)
In rare cases where there are complications they will include:
🟠Tibial plateau fractures can cause arthritis in the knee joint, leading to pain.
🟠Stiffness in the knee while bending and straightening, and trouble with activities.
Patients who developed septic arthritis following internal fixation of a tibial plateau fracture were likely to endure long-term sequelae (Campbell,2022)
AP x-ray of a patient from the series with a closed bicondylar tibial plateau fracture (Campbell,2022)
The patient initially underwent spanning external fixation and closed reduction, followed by internal fixation with anterolateral and posteromedial approaches, as shown in b and c.
Nearly 1 year later, the patient developed septic arthritis and underwent four debridement procedures, eventually including implant removal. (Campbell,2022)
🟠Ultimately, he developed chronic infection and loss of joint space (d) before he was lost to follow-up
However, studies of over 8000 patients found that less than ten percent of patients developed post-traumatic arthritis symptomatic enough to require subsequent arthroplasty (Campbell,2022)
Complications after a tibial fracture are very rare, when they occur, they may include stiffness, delayed in consolidation, pain and arthritis.
▶️How long does swelling last after a tibial plateau fracture?
Swelling of a knee is referred to as oedema in medical terms, most patients I have seen after a tibial knee fracture do have swelling that persists for a long time.
The knee remains swollen for at least a few weeks after a tibial plateau fracture and this can last for several months.
🟠After 4 weeks when you have had your injury, the swelling area of the affected limb significantly will reduced compared with the pre-intervention period.
🟠Most of the swellings will subside with time, but a small percentage of them persisted for a duration of 2 years or more after injury (Pun,1989)
Here is another article about the causes and treatment of knee swelling with or without an injury.
▶️Is it normal to experience pain after a tibial plateau fracture?
It is very common to experience prolonged pain after you have had treatment for a tibial plateau fracture, reason being:
These are usually high impact injuries that result in other associated injuries around the knee.
Pain should not panic you to think that there is a problem, pain is a complex phenomenon, and everyone will experience it differently.
According to medical studies and patients experience (Wu 2022)
🟠Pain can be caused due to intra-articular inflammation.
🟠Soft tissue injury
🟠Changes in innervation pattern following the fracture.
Following weeks of tibial fracture, you will experience pain which should be relieved by the usual means.
⬛Try to stay active of course taking pain into consideration and following your doctors’ instructions.
⬛Your doctor should have given you pain medication to help with the pain.
⬛You can apply cold ice. Some people say it helps with pain.
⬛Find movements and positions that will help you relieve pain.
⬛Focus on rest and elevation it helps to reduce swelling and pain.
⬛Try to eat healthy and avoid smoking to help with healing.
▶️ When walking and weight bearing after tibial plateau fracture? Can you walk on a fractured tibial plateau?
Regardless of the type of tibial plateau fracture you have got, you can start walking right away. You may be able to put more or less weight on your foot.
However, you will likely need to adapt your walking style and put more or less weight on the affected leg.
Your doctor may usually recommend these three options.
1️⃣Your fracture is stable
If your fracture is stable enough and your doctor thinks healing will occur with weight bearing (Rare), then you can weight bear. Though pain may limit you a bit, you may need crutches for a few weeks.
2️⃣Your fracture is unstable
If your fracture is severely unstable, there is a risk of improper healing if you bear too much weight on it. In such cases your doctor may advise you to.
⬛Put partial weight bearing on your leg, meaning you can put your foot down without putting your body weight on it for at least 6 to 12 weeks.
⬛If you are restricted from putting any weight on the affected leg, strictly avoid weight bearing until a follow up x-ray shows good healing which usually takes 8 to 12 weeks. You can walk with crutches only on the good leg.
Iliopoulos,2020
▶️Can I bend my knee with a tibial plateau fracture?
Yes, with a tibial plateau fracture, it’s generally safe to start bending your knee immediately, especially if you didn’t have surgery.
If you had surgery, then you can start bending the knee to 90 degrees 1 week after surgery. Once the incision is fully healed (10-14 days) you can go past 90 degrees of knee bend.
Your doctor will be able to instruct you to start bending your knee as soon as possible to prevent stiffness and promote healing.
▶️Do you need to wear a knee brace after a tibial plateau fracture?
I have seen some patients with and without a brace after a tibial fracture.
Multiple medical studies have included the use of bracing, no bracing or a mix of both with good results after a post-operative surgery.
Some state that bracing may be beneficial after surgery of a plateau fracture. And others state, bracing to have a potential drawback related to fitting, wound complications, and compliance (Chauhan,2018)
So, if your orthopaedic doctor has not prescribed you one, then it means you probably do not need it. When a brace is prescribed (see on Amazon example of knee brace) it is generally for one of these reasons.
⬛You may need one for support and work on gentle motion to prevent stiffness.
⬛To help with gentle motion, which can also help the cartilage heal and if you have lost strength in the quadriceps muscles that prevent the knee from giving away.
⬛If your surgical team believes wearing a bracing will be helpful to speed up consolidation.
⬛If you have instability of the knee joint and a brace will help reduce the risk of knee buckling.
The use of the brace could vary from 10 days to 6 weeks depending on how severe your injury is or what your doctor recommends.
▶️Tibial plateau fracture rehab protocol and physical therapy
Tibial plateau fracture injuries have been reported to have a significant negative impact on the patients’ lives, decreasing their quality of life, keeping them off work for long periods of time and reducing their activity levels.
Physical therapy is a very important part of your rehabilitation during your journey to return to your pre-injury activity levels like before:
A physiotherapy will help you with:
♦️Any concerns you may have about your healing.
♦️Early range of motion exercises.
♦️️ Show you how to bear partial or full weight bearing.
Physical therapy should initially focus on isometric quadriceps exercises and subsequently progress from passive to active assist to active range of motion (Rozell,2016)
Until you get better and more confident to walk without pain or any discomfort, try to take it easy and allow your body to heal.
We have come to the end of this article, wishing you a quick recovery!🙋
📚Source:
Rudran B, Little C, Wiik A, Logishetty K. Tibial Plateau Fracture: Anatomy, Diagnosis and Management. Br J Hosp Med (Lond). 2020 Oct 2;81(10):1-9. doi: 10.12968/hmed.2020.0339. Epub 2020 Oct 30. PMID: 33135915.
Rozell JC, Vemulapalli KC, Gary JL, Donegan DJ. Tibial Plateau Fractures in Elderly Patients. Geriatr Orthop Surg Rehabil. 2016 Sep;7(3):126-34. doi: 10.1177/2151458516651310. Epub 2016 Jun 6. PMID: 27551570; PMCID: PMC4976737.
Image from: https://ota.org/for-patients/find-info-body-part/3834#/+/0/score,date_na_dt/desc/
Luo CF, Sun H, Zhang B, Zeng BF. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma. 2010 Nov;24(11):683-92. doi: 10.1097/BOT.0b013e3181d436f3. PMID: 20881634.
Campbell ST, Taylor M, Dunbar RP, Firoozabadi R. Long-term sequelae of septic arthritis after tibial plateau fracture fixation: does timing matter? Arch Orthop Trauma Surg. 2022 Jun;142(6):955-959. doi: 10.1007/s00402-020-03730-x. Epub 2021 Jan 8. PMID: 33417025.
Pun WK, Chow SP, Fang D, Cheng CL, Leong JC, Ng C. Post-traumatic oedema of the foot after tibial fracture. Injury. 1989 Jul;20(4):232-5. doi: 10.1016/0020-1383(89)90121-6. PMID: 2592102.
Wu Y, Zhou J, Zhu F, Zhang M, Chen W. The effects of pain relief on proprioception and muscle strength for tibial plateau fractures: A randomized controlled trial. Musculoskelet Sci Pract. 2022 Dec;62:102658. doi: 10.1016/j.msksp.2022.102658. Epub 2022 Aug 24. PMID: 36037744.
Chauhan A, Slipak A, Miller MC, Altman DT, Altman GT. No Difference Between Bracing and No Bracing After Open Reduction and Internal Fixation of Tibial Plateau Fractures. J Am Acad Orthop Surg. 2018 Mar 15;26(6):e134-e141. doi: 10.5435/JAAOS-D-16-00021. PMID: 29517625.
Iliopoulos E, Galanis N. Physiotherapy after tibial plateau fracture fixation: A systematic review of the literature. SAGE Open Med. 2020 Oct 14;8:2050312120965316. doi: 10.1177/2050312120965316. PMID: 33133602; PMCID: PMC7576901.
Robertson GAJ, Wong SJ, Wood AM. Return to sport following tibial plateau fractures: A systematic review. World J Orthop. 2017 Jul 18;8(7):574-587. doi: 10.5312/wjo.v8.i7.574. PMID: 28808629; PMCID: PMC5534407.