A 44-year-old female with diabetes and end-stage renal disease suffered a nondisplaced medial tibial plateau fracture after a ground-level fall. After open reduction and internal fixation, her popliteal artery and vein occluded at the level of the fracture. Review of the noncontrast computed tomography scan completed on initial arrival to the emergency department revealed a fracture in the calcified media of the popliteal artery at the level of the arterial occlusion. The propensity of different classes of tibial plateau fractures to be associated with soft-tissue and vascular injuries is examined in the context of different imaging modalities. The pathogenesis of arterial calcification and arterial dissection (including patients with renal disease and diabetics) is reviewed.