Schatzker Classification (Tibial Plateau Fracture)

Schatzker classification (tibial plateau fracture) is a special type with a fracture is one method of classifying, investigating the fracture pattern, severity, degree, and fracture angle of tibial plateau fractures there fall into six types lateral plateau fracture without depression (type I), lateral plateau fracture with depression (type II), compression fracture of the lateral (type IIIA) or central (type IIIB) plateau, medial plateau fracture (type IV), bicondylar plateau fracture.

The Schatzker classification system for tibial plateau fractures is universally and widely accepted by orthopedic surgeons to assess the initial injury, plan management, and predict prognosis. The most common fracture of the tibial plateau is type II.

This system divides tibial plateau fractures into six types:

  • Schatzker I: wedge-shaped pure cleavage fracture of the lateral tibial plateau, originally defined as having less than 4 mm of depression or displacement
  • Schatzker II: splitting and depression of the lateral tibial plateau; namely, type I fracture with a depressed component (generally considered commonest 5)
  • Schatzker III: pure depression of the lateral tibial plateau; divided into two subtypes:
    • Schatzker IIIa: with lateral depression
    • Schatzker IIIb: with central depression
  • Schatzker IV: medial tibial plateau fracture with a split or depressed component
  • Schatzker V: wedge fracture of both lateral and medial tibial plateau
  • Schatzker VI: transverse tibial metadiaphyseal fracture, along with any type of tibial plateau fracture (metaphyseal-diaphyseal discontinuity).

or

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)

Controversies

  • Does not include fractures within the coronal plane or others not seen on plain AP radiographs
  • Tibial plateau fractures that were operatively managed had better outcomes than people who 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 doesn’t dwell the arrangement suggests by Schatzker
  • Interobserver reliability varies with the Schatzker classification as only plain radiographs are used. this might be improved by adding other imaging modalities, like CT or MRI to the plain radiograph, but no current literature is sold on advanced imaging being a necessity for the needs of the arrangement on its own.
  • In terms of surgical planning, the utilization of cross-sectional imaging are more accurate than the plain AP radiographs utilized in the Schatzker arrangement

References