Schatzker classification of tibial plateau fractures

Description

The Schatzker classification system divides tibial plateau fractures into six types

  • Schatzker I: lateral tibial plateau fracture, with minimal (<4mm) depression or displacement.
  • Schatzker II: lateral tibial plateau fracture with fragment depression
  • Schatzker III: compression fracture of the lateral (IIIA) or central (IIIB) tibial plateau
  • Schatzker IV: medial tibial plateau fracture with split/depressed component
  • Schatzker V: bicondylar (lateral and medial) tibial plateau fractures
  • Schatzker VI: transverse tibial plateau fracture with metaphyseal-diaphyseal discontinuity (also known as Type C articular fracture in the AO classification)
Schatzker

History

1951 – Attempts at classifying tibial plateau fractures were first made in the 1950’s by Palmer

1956 – Further classifications for tibial plateau fractures put forward by Hohl and Luck and further refined by Hohl in 1967

Common themes for these fractures were established at this time, including fracture of one condyle or bicondylar involvement and subchondral depression.

1979Joseph Schatzker published a formal classification system for tibial plateau fractures by using AP radiographs of a group of 94 patients. The emphasis on this classification system was to guide treatment with relation to the original fracture pattern and mode of injury

Many other classification systems for tibial plateau fractures have since been described including that from Khan et al. (2000), however the Schatzker and AO/OTA systems remain the two used most commonly today


Associated Persons

Controversies
  • Does not include fractures in the coronal plane or others not seen on plain AP radiographs
  • Tibial plateau fractures that were operatively managed had better outcomes than those that were managed non-operativley; but patients with a tibial plateau fracture and associated osteoporotic bone had poorer outcomes when managed operatively than non-operatively.
  • Soft tissue injury is another management consideration for tibial plateau fractures, but it does not lie in the classification system put forward by Schatzker
  • Interobserver reliability varies with the Schatzker classification as only plain radiographs are used. This may be improved by adding other imaging modalities, such as CT or MRI to the plain radiograph, but no current literature is sold on advanced imaging being a necessity for the purposes of the classification system on its own.
  • In terms of surgical planning, the use of cross-sectional imaging are more accurate than the plain AP radiographs used in the Schatzker classification system

References
  • Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968 – 1975. Clin Orthop Relat Res. 1979 Jan-Feb;(138):94-104. [PMID 445923]
  • Müller ME, Nazarian S, Koch P, Schatzker J. The Comprehensive Classification of Fractures of Long Bones. Springer 1990
  • Markhardt B, Gross J, Monu J. Schatzker Classification of Tibial Plateau Fractures: Use of CT and MR Imaging Improves Assessment. Radiographics. 2009;29 (2): 585-597.
  • Zeltser D, Leopold S. Classifications in Brief: Schatzker Classification of Tibial Plateau Fractures. Clin Orthop Relat Res. 2013 Feb; 471(2):371-374. [PMC3549155]
  • Palmer I. Fractures of the upper end of the tibia. J Bone Joint Surg Br. 1951;33:160-166 [PMID:14832314]
  • Hohl M, Luck JV. Fractures of the tibial condyle; a clinical and experimental study. J Bone Joint Surg Am. 1956 Oct;38-A(5):1001-18. [PMID: 13367078]
  • Hohl M. Tibial condylar fractures. J Bone Joint Surg Am. 1967;49:1455–1467 [PMID: 6053707]
  • Khan RM, Khan SH, Ahmad AJ, Umar M. Tibial plateau fractures: a new classification scheme. Clin Orthop Relat Res. 2000;375:231–242. [PMID: 10853174]
  • Walton NP, Harish S, Roberts C, Blundell C. AO or Schatzker? How reliable is classification of tibial plateau fractures? Arch Orthop Trauma Surg. 2003;123:396–398 [PMID: 14574596]

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Dr Zach Joseph Orthopaedic Service Registrar, Western Australia | LinkedIn |

Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and informatics. Asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | vocortex |

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