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The authors are from the Department of Orthopedic Surgery (S-MC, M-WY, S-CD, QL, ZG), Yangpu Hospital, Shanghai; and Tongji Hospital (Y-QZ), Tongji University School of Medicine, Shanghai, PR China.
Drs Chang and Zhang contributed equally to this work and should be considered as equal first authors.
The authors have no relevant financial relationships to disclose.
Tibial plateau fractures involve the articular surface (plateau) and adjacent metaphysic (condyle) of the proximal tibia. The most common systems for classifying tibial plateau fractures are the Schatzker classification1 and the AO/OTA classification.2 The Schatzker classification, first described in 1979, is now popular throughout the world3 and divides fractures into unicondylar (types I-IV) and bicondylar (types V and VI) fractures. The fractures can also be divided into low-energy variants (types I-III) and high-energy variants (types IV-VI). In the Schatzker system, fracture types are classified in what was presumed to be an increasing order of severity. However, Schatzker1 later believed that the type IV fracture carried the worst prognosis, likely due to its high variability and combination of bony and soft tissue injuries.
Schatzker type IV fractures occur in the medial plateau. The fracture lines of a type IV fracture are usually described as lying in the sagittal plane, and medial buttress plating is widely recommended as a treatment.1 In 2007, Wahlquist et al4 further classified type IV fractures into 3 subtypes according to the sagittal fracture line location: either medial to (subtype A), within (subtype B), or lateral to (subtype C) the intercondylar spines. These fractures were also described by Moore5 in 1981 as fracture-dislocation/subluxation and classified as Moore types I and II.
Compared to plain radiographs, computed tomography (CT) scans can provide more detailed information about intra-articular fractures. Through the widespread use of CT, the authors have found that in some type IV cases--especially in posteromedial shearing fractures--the fracture line may appear in the coronal plane.6,7 In clinical practice, the coronal posteromedial fragment is difficult to stabilize through a standard medial approach with a medial buttress plate. In addition, these posteromedial fractures are often complicated by posterolateral tibial plateau impaction, which is difficult to reduce and fix.
The fracture pattern dictates the treatment plan, the risk for complications, and, to some extent, the patient outcome. Because different fracture patterns...