For a depressed tibial plateau fracture, which finding most strongly suggests the need for operative fixation?

• A. Mild depression without instability.
• B. No depression and stable alignment.
• C. Isolated fibular fracture.
• D. Significant depression or joint instability.

Answer: (D)

The key idea is that restoring the joint surface and knee stability drives the decision for surgery in depressed tibial plateau fractures. When the articular surface is significantly depressed or the knee is unstable, the normal load transmission through the joint is disrupted and the risk of malunion and post‑traumatic arthritis is high. Operative fixation aims to realign the articular surface, restore limb alignment, and provide stable fixation that allows early motion, which protects the joint in the long term.

If depression is mild and the knee remains stable, nonoperative treatment with immobilization and gradual rehabilitation can be appropriate, since the joint surface remains relatively congruent and the overall alignment is preserved. An isolated fibular fracture by itself, without depression or instability of the tibial plateau, does not mandate knee fixation; the tibial plateau injury—especially if it involves depression or instability—drives the need for fixation.