An unclassified tibial plateau fracture: Reverse Schatzker type IV

Abstract

The most commonly accepted system of classification for tibia plateau fractures is that of Schatzker. Increasingly, both high energy injuries and atypical osteoporotic fragility failures have led to more complex, unusual and previously undescribed fracture patterns being recognized. We present a case of a patient with a previously unreported pattern of tibia plateau fracture and knee dislocation. We highlight the challenges confronted and present the management and the outcomes of his injury. A 28-year old male motorcyclist was involved in a head on collision with a truck and was transferred by helicopter to our level 1 major trauma centre emergency department. His injuries were a circumferential degloving injury to his left leg and a right lateral tibial plateau fracture/knee dislocation. The pattern of the lateral tibial plateau fracture was unique and did not fit any recognised classification system. The patient received a spanning external fixator initially and after latency of 12 days for soft tissue resuscitation he underwent definite fixation through an antero-lateral approach to the proximal tibia with two cannulated 6.5 mm partially threaded screws and an additional lateral proximal tibia plate in buttress mode. A hinged knee brace was applied with unrestricted range of motion post-operatively and free weight bearing were permitted post operatively. At the 6 months follow up, the patient walks without aids and with no limp. Examination revealed a stable joint and full range of motion. Plain radiographs revealed that the fracture healed with good alignment and the fixation remained stable. High energy injuries can lead to more complicated fracture patterns, which challenge the orthopaedic surgeons in their management. It is crucial to understand the individual fracture pattern and the possible challenges that may occur. This study reports a lateral tibia plateau fracture/dislocation which perhaps is best described as a reverse Schatzker IV type fracture.

“Flip lid” type of lateral tibia plateau fracture with a meniscus radial tear: A case report

“…We created a new term, tibial plateau fracture “flip lid,” to describe this fracture. Our speculation of the trauma mechanism was similar to that of “reverse-Schatzker type IV” fracture, which is caused by instant fracture dislocation with a valgus knee position [ 8 ].…”

3D mapping and classification of tibial plateau fractures

“… 16 However, the above classifications failed to depict the two special fracture lines that extended from the lateral cartilage facet to the medial cortex (Wahlquist Type C) 27 and from the medial cartilage facet to the lateral cortex. 28 The Yao classification established types 3 to 6 (homolateral/diaphyseal/contralateral/bilateral), and accordingly covered all injury types of the lateral and medial column. Hence, it was more comprehensive and beneficial for the determination of plate positioning.…”

Dual split and dislocation----a variant of Schatzker type-I tibial plateau fracture: A case report

“…However, in the last decade column theory 2 , 3 has led to routine use of CT scan in management of tibial plateau fracture, which has revealed multiple patho-anatomical variants of tibial plateau fracture. 4 , 5 To overcome the initial limitation and to incorporate such variants, the detailed fracture description revisiting the Schatzker classification based on CT scan published. 6…”