Revisiting the Schatzker classification of tibial plateau fractures

Abstract

A B S T R A C TTibial plateau fractures have a broad spectrum of presentations, depending on the mechanism and energy of the trauma. Many classification systems are currently available to describe these injuries. In 1974, Schatzker proposed a classification based on a two-dimensional representation of the fracture. His classification with the six-principles types became one of the most utilized classification systems for tibial plateau fractures. More than four decades after this original publication, we are revisiting each fracture type in the light of information made available by computed tomography, which today comprises a standard tool in assessing articular fractures. The classification we are proposing relies on the fact that the tibial plateau has two anatomical columns, lateral and medial. We are introducing a virtual equator which splits the articular surface in the coronal plane. The equator divides each column into two quadrants, the anterior (A) and the posterior (P). Unicondylar fracture types (I to IV) have now additional modifiers A (anterior) and P (posterior) to describe the exact spatial location of the primary fracture plane. Bicondylar fracture types (V and VI) have the modifiers (A and P) of the main fracture plane for each column, and lateral (L) and medial (M) to denote the column. We are introducing the concept of the main fracture plane. Recognition of the exact location of the principal fracture plane is essential for preoperative planning of patient positioning, surgical approach and for determining where to apply the hardware to achieve stable fixation. The new three-dimensional classification is based on the template of the original Schatzker classification. It covers the mechanism of the injury, the energy of the trauma, the morphologic characteristics of the fracture and its location in three dimensions.

Non-locked and locked small fragment straight plates have a similar behavior in buttressing the posteromedial shear tibial plateau fragment: a biomechanical analysis of three different fixations

“…6 Load-to-failure for the TTP and DCP experimental groups (mean and CI 95%) sagittal angle, highly indicative of shear instability and vertical displacement [2]. There is a general consensus that the posteromedial fragment should be directly reduced through a posteromedially based approach and fixed with a buttress plate placed to the apex of the triangular fragment [5,8]. However, the definition of which plate should be used continues a matter of debate with some authors reporting the placement of different plates in the tibial plateau for buttressing the posteromedial fragment.…”

Anatomical and Clinical Rationale for Posterolateral Transfibular Approach for Internal Fixation of the Posterolateral Column of the Tibial Plateau

“…наиболее часто применяются в клинической практике классификации переломов аО и j. Schatzker [6], однако они практически не учитывают особенности повреждений задних отделов мыщелков ББК, что затрудняет рациональный выбор хирургических доступов и приемов при лечении пациентов. Поэтому в последние годы были предложены трех-и четырехколонная классификации переломов плато ББК, которые выделяют задние участки мыщелков в одну или две дополнительные колонны, что позволяет учитывать клинически значимые крупные фрагменты в задних отделах плато ББК при выборе лечебной тактики [7,8,9,10,11]. небольшом количестве наблюдений, что не позволяет определить показания к его практическому использованию в различных клинических ситуациях [2,7,14,16].…”

Characterization of bone fragment displacement during minimally invasive surgical procedures by digital volume correlation (DVC)

“…For several years, in traumatic surgery, techniques have evolved towards minimally invasive methods. In 2013, Vendeuvre et al published a new minimally invasive technic, named Tuberoplasty, to treat Schatzker type II fractures (Vendeuvre et al 2013) (Kfuri and Schatzker 2018). This type of fracture corresponds to the splitting and depression of the lateral tibial plateau and mostly occurs in fall from height cases.…”