Anatomic restoration of an isolated medial tibial plateau depression in a young patient after high-energy trauma

Rationale: Isolated medial tibial plateau depression fractures are uncommon injuries. Elevation of the depressed articular surface is traditionally supplemented with bone grafting or bone substitute to support the subchondral defect. However, the necessity of graft augmentation in selected fracture patterns remains uncertain. Patient concerns: An 18-year-old male presented with right knee pain and swelling following a high-energy motorcycle accident. Diagnoses: Radiographs and computed tomography demonstrated an isolated medial tibial plateau depression fracture with minimal displacement (≤ 10 mm), classified as Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association 41-B1.2. Interventions: The depressed articular surface was anatomically elevated and stabilized using a proximal medial locking plate without bone graft or bone substitute augmentation. Outcomes: The patient remained non-weight-bearing for 12 weeks, and radiographic union was achieved by 3 months. At the 12-month follow-up, radiographs demonstrated maintained anatomic reduction with < 1 mm residual articular depression, no implant-related or wound complications, and the Knee Injury and Osteoarthritis Outcome Score improved from 2 to 71. Lessons: This case suggests that, in carefully selected isolated medial tibial plateau depression fractures, stable anatomic reduction and rigid subchondral fixation may provide favorable clinical and radiographic outcomes without routine graft augmentation. Larger clinical studies are needed to further define the indications for this treatment strategy.