|Operative vs nonoperative|
Undisplaced fractures with retained stability of the joint do not require surgical treatment. They require protection in a fracture brace to prevent displacement.
The exceptions to this rule are fractures involving the medial tibial plateau B3.2 and B3.3 because in these, even if undisplaced, there is a high risk of secondary displacement. A further exception would be complications requiring surgical treatment.
Surgery is required if the joint is unstable, if the articular surface is fractured and displaced, if there is axial deformity, and if the fracture involves the medial condyle.
Surgery is required if there is joint instability, articular surface incongruity, and axial deformity.