Classifications in brief: Schatzker classification of tibial plateau fractures.

Early attempts at classifying tibial plateau fractures by Palmer in 1951 [25], Hohl and Luck in 1956 [15], and Hohl in 1967 [15] recognized some of the major themes common to many classification systems for these fractures: split of a condyle, subchondral depression, and comminuted bicondylar involvement. Schatzker et al. published their classification system in 1979 [29], deriving it from the AP radiographs of a series of 94 patients, most of whose tibial plateau fractures were treated nonoperatively [34]. They divided tibial plateau fractures into six types (Fig. 1): split fracture of the lateral tibial plateau (Type I), split depression of the lateral tibial plateau (Type II), central depression of the lateral plateau (Type III), split of the medial tibial plateau (Type IV), bicondylar tibial plateau fracture (Type V), and dissociation between the metaphysis and diaphysis (Type VI; also known as a Type C articular fracture in the AO/OTA classification). The first types involve only the lateral tibial plateau. Type III (depression) fractures were caused by low-energy injuries in osteopenic bone whereas all other types resulted from high-energy injuries [29]. Types IV to VI often result from motor vehicle collisions, motorcycle collisions, and falls from a height [1]. Finally, although the first four types are unicondylar fractures, Types V and VI are bicondylar. Schatzker et al. emphasized that their classification system, hereafter referred to as the Schatzker system, was based on fracture pattern. Also, each fracture’s pattern, as they classified, helped to direct the appropriate operative treatment modality, such as lag screws, buttress plates, or both (as sometimes is done for bicondylar fractures), and to point to the need for elevation of the depressed joint surface and maintenance with bone graft (for depressed fractures). They noted that operatively treated fractures had better results than those treated nonoperatively and that osteoporotic bone fared worse in patients treated operatively and nonoperatively [29].