Schatzker classification of tibial plateau fractures

Schatzker classification system is one method of classifying tibial plateau fractures.

Increase in type number denotes increasing severity, reflecting an increase in energy imparted to the bone at the time of injury and also an increasingly worse prognosis ¹. The most common fracture of the tibial plateau is type II.

Classification

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)

History and etymology

This classification was first published by Joseph Schatzker et al. in 1979 ⁴.

Practical points

• detection of a lipohemarthrosis on a knee radiograph without evidence of a displaced fracture should raise concern for a tibial plateau fracture and CT should be arranged
• the normal lateral tibial plateau is flat, whereas the medial plateau is slightly convex
• the CT report should state the amount of fracture depression from the joint line

See also

• eponymous fractures