Which nerve is at risk with a tibial plateau fracture?

• A. Femoral nerve
• B. Obturator nerve
• C. Sciatic nerve divisions (tibial branch) and common peroneal nerve depending on fracture pattern.
• D. Sural nerve

Answer: (C)

Injury to nerves around the knee from a tibial plateau fracture depends on how the fracture propagates, because the sciatic nerve splits into its two branches—the tibial nerve and the common peroneal nerve—near the popliteal fossa. If the fracture disrupts the posterior aspect or involves the tibial-side structures, the tibial branch can be affected. If the fracture travels laterally or around the fibular neck area, the common peroneal branch is at risk. Since either or both branches can be involved based on the fracture pattern, nerves arising from the sciatic nerve are the ones at risk. The sural nerve is a sensory branch that may be affected in some injuries, but it is not the primary nerve at risk in typical tibial plateau fractures. The femoral and obturator nerves lie higher up in the thigh and are not usually endangered by fractures at the knee joint.