High-energy fractures of the tibial plateau.

High-energy tibial plateau fractures are often the result of blunt trauma. In addition to extensive bony injuries, soft-tissue problems are very common. Preoperative planning for surgical repair of these injuries is invaluable. Contemporary internal fixation techniques using ligamentotaxis, percutaneous fixation, and antiglide techniques provide the basis for internal fixation of these injuries. When extensive comminution and damaged soft tissues prohibit their use, the circular external fixator provides an excellent option for management of these complex injuries. Whether internal or external fixation techniques are used, appropriate management of the soft tissues is also a factor in the successful management of these severe injuries to the knee.