Fractures of the tibial plateau are increasing in incidence because of their relationship with sports and traffic accidents (4.83% of the total). They may be extraordinarily serious, sometimes unsolvable, leaving sequels of rigidity and of post-traumatic degenerative arthritis that may need osteotomies, arthrodesis or joint replacements at a later date. However, a meticulous surgical procedure is usually rewarded. It is the typical cancellous bone surgery, that has very little to do with the surgery of the diaphyseal bone as far as the internal fixation is concerned.

The surgical approaches must preserve the blood supply of the skin and allow direct intra-articular vision. The common mechanisms of fracture, acting on cancellous bone covered by weak cortices, frequently result in bone loss because of the crushing, making addition of bone graft, autologous or freeze-dried, a predictable surgical step. The reduction and the bone graft must be protected from the loads by a scaffold of screws, with or without interfragmentary compression. These screws are usually associated to plates with a buttress effect. In the fractures that involve the metaphyseal area, sometimes it will be necessary to use two plates in order to substitute the weak cortices and the weight-bearing will always have to be delayed until healing, even though there may be early function.

As it is for the fractures of the segment 33-, reduction of the articular fracture is very important but also important is the reduction of the metaphyseal fracture because it determines the alignment of the extremity.