Medial Tibial Plateau Fractures and Fracture-Dislocations: A Mechanism-Based Narrative Review of Instability Patterns, Imaging, and Contemporary Management

Medial tibial plateau fractures and fracture-dislocations are uncommon but potentially limb- and function-threatening injuries caused mainly by high-energy trauma, and often associated with complex fracture morphology, soft-tissue damage, and neurvascular compromise. Early identification of the fracture patterns is essential to lower the risks of malreduction ,persistent instability, stiffness, and accelerated post-traumatic osteoarthritis. This narrative review aimed to synthesize contemporary evidence on the anatomic and biomechanical basis, injury mechanisms, diagnostic work-up, classification, and management of medial tibial plateau fractures and fracture-dislocations. Following Scale for the Assessment of Narrative Review Articles (SANRA) guidelines, we conducted a literature search of PubMed, MEDLINE, and Google Scholar from inception to March 2025 and prioritized clinically relevant studies addressing imaging pathways, fracture morphology, instability patterns, and integrated osseous-ligament management. Contemporary evidence supports computed tomography, including three-dimensional reconstruction, as the reference standard for defining fracture anatomy, identifying posterior and posterolateral extension, and guiding fixation strategy, while magnetic resonance imaging frequently detects associated meniscal and ligamentous injuries that may alter surgical planning. Traditional classifications such as Schatzker and AO/OTA remain useful for initial assessment but incompletely characterize the morphologic heterogeneity and soft-tissue burden of these injuries; newer CT-based and mechanism-oriented frameworks may better inform treatment decisions. Operative management plan is individualized based on the fracture morphology, soft-tissue condition, and extension of the injury, with some patterns necessating combined approaches and robust buttress fixation. Optimal outcomes depend on systematic pattern recognition, comprehensive imaging, anatomic reduction with stable fixation, and coordinated management of associated soft-tissue injury.