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Tibial Plateau Fractures

The tibial plateau can be fractured with varying degrees of severity but these fractures represent complex injuries. Probably the most widely used classification for tibial plateau fractures is the one devised by Joseph Schatzker in 1990. Broadly speaking the classification can be detailed as follows.

Shatzker type I - Split fracture of the lateral tibial plateau without depression.
Aetiology: When young patients with strong bones which resist depressive forces subject their tibia to a valgus stress. May be the result of a bumper injury.
Associated injuries: May trap the lateral meniscus in the fracture site and require arthroscopy. Lateral meniscal tears are associated with Shatzker type I injuries.
Rx: Lateral internal fixation.

Shatzker type II - Split with depression of the lateral tibial plateau.
Aetiology: Older patients with bones that are osteoporotic suffer a valgus or a axial stress. The bones are unable to resist the depressive forces.
Associated injuries: Lateral and medial meniscus and medial collateral ligament.
Rx: Depressed fragments elevated with bone graft and lateral internal fixation.

Shatzker type III - Lateral depression of the lateral tibial plateau.
Aetiology: Older patients with a degree of osteoporosis who have fallen. 
Associated injuries: Lateral and posterior depressed fragments imply joint instability
Rx: Joint instability requires depressed fragments to be elevated and bone graft is used to support them. Internal fixation on the lateral aspect is also required.

Shatzker type IV - May involve the tibial spines. Medial plateau fracture that may be split or depressed.
Aetiology: Severe trauma and varus stress.
Associated injuries: Intercondylar eminence avulsion, suggesting anterior cruciate ligament injury. Popliteal artery and peroneal nerve injuries and lateral collateral ligament injury. 
Rx: Medial plate and screws.

Shatzker type V - Split medial and lateral tibial plateau with contiguous metaphysis and diaphysis.
Aetiology: Axial stress with severe trauma.
Associated injuries: anterior cruciate ligament, meniscal ruptures and neurovascular injury.
Rx: Internal fixation to medial and lateral aspects of the tibia.

Shatzker type VI - Metaphyseal fracture separating articular surface from the diaphysis. May involve both surfaces or just be a medial or a lateral injury. 
Aetiology: High energy trauma.
Associated injuries: anterior cruciate ligament, meniscal ruptures and neurovascular injury, collateral ligaments and possible compartment syndrome.
Rx: Internal fixation to medial and lateral aspects of the tibia.

This illustration is the AO/OTA classification of proximal tibial fractures All images on this page are provided by kind permission of Yasser Alwabli,  Resident, Orthopedic Surgeon Demonstrator, Qassim University Faculty of Medicine

This illustration is the AO/OTA classification of proximal tibial fractures

All images on this page are provided by kind permission of Yasser Alwabli, 
Resident, Orthopedic Surgeon Demonstrator, Qassim University Faculty of Medicine

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