Tibial Plateau Fractures | Lower Extremity Trauma

Tibial Plateau Fractures

  • Schatzker Classification
    tibial plateau tibia split depression schatzker moore knee dislocation hohl & moore

    Schatzker Classification of Tibial Plateau Fractures

    • I – Lateral plateau split
      • young people with good bone
      • lateral meniscus tear trapped in fracture
    • II- Lateral plateau split-depression
      • valgus blow with axial loading
      • age > 40
    • III – Lateral plateau depression (tend to be stable)
    • IV – Medial plateau fracture (15% of plateau fractures)
      • less common
      • associated with LCL injury
      • pattern most commonly associated with vascular injury
      • may represent knee dislocation that has been spontaneously reduced
    • V – Bicondylar fracture
    • VI – Bicondylar plateau + shaft fracture
      • * 60% of fractures are lateral plateau fractures (Types I-III)
      • ** 25% of fractures are bicondylar fractures (Types V-VI)
  • Moore & Hohl Classification
    tibial plateau tibia split depression schatzker moore knee dislocation hohl & moore   tibial plateau tibia split depression schatzker moore knee dislocation hohl & moore

    Moore & Hohl Classification of Tibial Plateau Fractures – A. Brunner et al. / Injury, Int. J. Care Injured 41 (2010) 173–178

    • I – Coronal split fracture
    • II – Entire condylar fracture
    • III – Rim avulsion fracture
    • IV – Rim compression fracture
    • V – Four part fracture
  • Comparison Between Schatzker and the Hohl & Moore Systems
Hohl Classification Schatzker Classification
Type I Same as Hohl Type I
Type II Type III
Type III Type II
Type IV Same as Hohl Type IV
Type V Same as Hohl Type V
Type VI Same as Hohl Type IV
Indications for Nonoperative Treatment
  • stable
  • no more than 10 degrees of varus or valgus at 0 degrees of extension
  • less than 3 mm of articular stepoff (more modern consensu)
  • put them in hinged knee brace, start motion at 3 weeks and motion at 6 weeks
Indications for Operative Treatment
  • more than 3mm stepoff
  • more than 5mm condylar widening
  • goals
    • stability 1st
    • stepoff next
  • can be treated stage for higher grade injuries
    • external fixation
    • you want early range of motion after fixation
  • Schatzker 1 – plate and screws
  • bone void fillers
    • allograft
    • calcium phoshpate cement has been shown to be stronger
    • calcium sulfate dissolves quickly
  • Use of locking screws has become more prevalent
    • you really don’t need locking screws for split depressed fractures
    • really all you need is a buttress plate
  • Bicondylar fractures
    • use locking here, especially if only using lateral plate
    • if no displacement on medial side you can use just one plate
    • if using two plates, usually don’t use a single anterior incision, use two incisions instead
  • Don’t place pins from ex-fix closer than 14mm to the joint line (this is where capsule extends down to)
  • Higher engergy
    • think about compartment syndromes
  • Bicondylar fracture
    • varus collapse
  • Don’t routinely get MRI, usually get CT
  • Lateral meniscus usually more injured than medial side (most are valgus force)
  • Up to 80% of the time there will be some type of soft tissue injury
  • Tibial eminence
    • more of a pediatric fracture
    • Classification
      • 1 – minimally displaced
      • 2 – tilted but not displaced
      • 3 – displaced
    • usually treat nonop but if displaced may need to fix with screw or suture