In tibial plateau fractures, ORIF is indicated to restore the joint surface when there is a:

• A. Non-displaced articular fracture with stable alignment
• B. Displaced articular fracture or instability
• C. Extra-articular fracture with intact joint surface
• D. Simple hairline fracture treated nonoperatively

Answer: (B)

Restoration of the joint surface is essential when the tibial plateau fracture involves the articular surface and is displaced or unstable. In these cases, open reduction and internal fixation is used to anatomically reduce the articular surface and stabilize the fracture, reestablishing smooth joint congruity and proper mechanical alignment. This allows early motion and helps prevent articular step-off, meniscal or ligament injury progression, and the development of post-traumatic arthritis.

If the articular surface is not displaced and the alignment remains stable, nonoperative management is appropriate, and there’s no need for ORIF. Extra-articular fractures that do not involve the joint surface likewise do not require joint-surface reconstruction. Simple hairline fractures treated nonoperatively follow the same principle: no disruption to the joint surface that would necessitate surgical restoration.