A comprehensive narrative review of high-energy tibial plateau fractures (Schatzker IV–VI) covering pathoanatomy, clinical and radiographic evaluation, staging principles, fixation options, and outcomes. The central question: how should injury energy and soft-tissue status dictate treatment strategy and timing?
When you see a high-energy tibial plateau fracture with swelling, blisters, or soft-tissue compromise, apply a knee-spanning external fixator first — do not rush to definitive ORIF. Wait for skin wrinkling and blister epithelialization, get a CT, then plan your definitive fixation; this sequence is what keeps infection rates out of the historic 50–80% range.
A comprehensive narrative review of high-energy tibial plateau fractures (Schatzker IV–VI) covering pathoanatomy, clinical and radiographic evaluation, staging principles, fixation options, and outcomes. The central question: how should injury energy and soft-tissue status dictate treatment strategy and timing?
When you see a high-energy tibial plateau fracture with swelling, blisters, or soft-tissue compromise, apply a knee-spanning external fixator first — do not rush to definitive ORIF. Wait for skin wrinkling and blister epithelialization, get a CT, then plan your definitive fixation; this sequence is what keeps infection rates out of the historic 50–80% range.