If a depressed tibial plateau fracture shows no significant depression or instability, what is the typical management?

• A. Nonoperative management.
• B. Immediate ORIF.
• C. Total knee replacement.
• D. External fixation.

Answer: (A)

When the articular surface isn’t significantly depressed and the knee remains stable, the fracture can heal well without surgery. The goal is to protect the injury while preserving motion, so nonoperative management is chosen. This typically involves immobilizing the knee with a long-leg cast or knee immobilizer and allowing protected weight bearing (often toe-touch or partial weight bearing) for about six weeks, followed by a structured program to regain range of motion and strength. Regular radiographs monitor for any late displacement. If the surface were depressed more or instability appeared, surgical repair would be considered. External fixation is generally reserved for soft-tissue concerns or unstable injuries, and total knee replacement is for certain elderly patients or cases where joint surfaces cannot be restored.