Tibial Plateau

Scenario

An 80 Year old female presented to A+E with knee pain after falling from standing height. 

Screenshot 2022-05-01 at 13.20.27

This is an AP and lateral X-Ray and Coronal and sagital CT slice of an unknown skeletally mature individuals Left knee. the most obvious abnormality is that there is a fracture through the lateral tibial plateau with evidence of joint depression. Classification would be a Shatzker 2.

Schatzker Classification

1

Lateral split fracture

2

Lateral split and depressed fracture

3

Lateral depressed fracture

4

Medial plateau fracture

5

Bicondylar fracture

6

Metaphyseal-diaphyseal disassociation

 

Meniscal tears

  • Lateral meniscal tears
    • Associated with Schatzker II fractures
    • Associated with >10mm articular depression
  • Medial meniscal tears
    • Most commonly associated with Schatzker IV fractures

ACL injury

  • More common in Type IV and VI fractures

Compartment syndrome

Vascular injury

  • Commonly associated with Schatzker IV fracture dislocations

Non operative treatment

  • Hinge knee brace, partial weight bearing for 8-12 weeks and immediate passive ROM
  • Useful for minimally displaced split or depressed fractures
  • Non ambulatory patients
  • Low energy fracture stable to varus/valgus alignment

 

Operative

  • External fixation
  • ORIF
  • Arthroplasty (consider in >65 year olds with osteoporotic bones)
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