Schatzker Type IV Medial Tibial Plateau Fractures: A Computed Tomography–based Morphological Subclassification

Abstract

Schatzker type IV medial tibial plateau fractures have an unfavorable prognosis, likely due to the mechanism of injury (fracture-dislocation/subluxation type) and possibly due to the involvement of the posterolateral plateau, which is different from previously thought. The aim of this study was to propose a new subclassification of Schatzker type IV fracture patterns based on 2-dimensional (2-D) computed tomography and three-dimensional (3-D) reconstruction. The authors defined Schatzker type IV medial tibial plateau fractures as AO/OTA 41 type B fractures (partial articular), with partial or total medial plateau involvement, leaving at least the anterolateral quadrant intact. The images of 42 fractures (42 patients) were evaluated. The fractures were further anatomically divided into 2 groups: Group 1 were classic medial unicondylar fractures and Group 2 were more complicated variants involving both condyles, characterized by medial condyle fractures with lateral plateau extension, usually with articular impaction of the centroposterior lateral plateau. Twelve (29%) cases involved only the medial condyle, and 30 (71%) involved both the medial and lateral condyles. Twenty-nine (69%) cases demonstrated posterior coronal fractures. The most common patterns were bicondylar posteromedial plateau fractures with posterolateral quadrant depression (bicondylar posterior fractures: 14 cases, 33%) and total/subtotal medial condyle fractures with posterolateral quadrant depression (13 cases, 31%). The isolated unicondylar posteromedial split fracture was uncommon (2 cases, 5%). Computed tomography-based reconstruction enhances the understanding of fracture anatomy and the relationships between fracture fragments. In Schatzker type IV medial tibial plateau fractures, the involvement of posterolateral quadrants is common.

An unclassified tibial plateau fracture: Reverse Schatzker type IV

“…Each subtype would further be defined by the fracture line location, the fracture line orientation and the fracture type (split, split-depressed etc). 2 As vast as this sub-classification was, it did not, however, contain a description of a lateral tibial plateau fracture-dislocation pattern as described in this case study.…”

“…Chang et al 2 identified a sub-classification within the Schatzker type IV fracture pattern. Essentially this described different variants of a Schatzker type IV fracture patterns and categorized them into eight subtypes.…”

“…The Schatzker type IV is considered to be a fracture caused by a high-energy mechanism of injury and accounts for approximately 10% of all tibial plateau fractures. 2 The fracture line of a type 4 typically passes through the medial tibial plateau in combination with a dislocated/subluxed knee joint ( Fig. 1 ).…”

“…Understanding the fracture pattern and the mechanism behind it is of great use to the operating surgeon as the pattern influences the surgical approaches and patient positioning, the fixation construct and rehabilitation protocol, allows early identification of any risks and complications and can even predict the prognostic outcome of the patient. 2 …”

Relative Incidence of Proximal Fibula Fractures with Tibial Plateau Fractures: An Investigation of 354 Cases

“…Compared with CT, AP radiography has a lower detection rate of proximal fibula fracture in associated with tibial plateau fractures. [18][19][20][21] Our findings demonstrated distinct fracture characteristics of these combined high-energy tibial plateau and fibula fractures owing to the use of a combination of the Schatzker's and three-column classification systems.…”