Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 May;37(5):911-7.
doi: 10.1007/s00264-013-1825-5. Epub 2013 Feb 22.

Morphological characteristics of split-depression fractures of the lateral tibial plateau (Schatzker type II): a computer-tomography-based study

Qilin Zhai  1 , Congfeng Luo, Yi Zhu, Ling Yao, Chengfang Hu, Bingfang Zeng, Changqing Zhang
Affiliations

Morphological characteristics of split-depression fractures of the lateral tibial plateau (Schatzker type II): a computer-tomography-based study

Qilin Zhai et al. Int Orthop. 2013 May.

Abstract

Purpose: The objective of this study was to evaluate the morphological characteristics of lateral tibial plateau split-depression fractures (Schatzker type II).

Methods: A retrospective analysis of radiographic and computed tomographic (CT) data of lateral tibial plateau split-depression fractures from January 2009 to December 2010 was conducted in a level 1 trauma centre. The discontinuity arc, angle of depression centre (ADC), anterior-posterior position of articular depression centre (APDC), surface area percentage (SAP), sagittal angulation and depression depth were measured on CT images using the Picture Archiving and Communication System.

Results: Based on the integrity of posterolateral wall and discontinuity arc, 140 cases of Schatzker type II fracture were divided into two subtypes: intact group (69 cases) and broken group (71 cases). The fracture of the intact group was located in the anterior part of the lateral plateau, the average ADC was 72.13°, APDC was 43.25 % of sagittal diameter, SAP was 22.16 % of total plateau, sagittal angulation was 6.59°and depression depth was 10.80 mm. Of the broken group, the average ADC, APDC, SAP, sagittal angulation and depression depth was 92.45°, 61.84 %, 22.63 %, 9.00° and 10.78 mm, respectively. Forty-seven cases in the broken group had a posterolateral fragment and 15 cases among them had articular depression centered in the posterolateral region. The difference in ADC, APDC and sagittal angulation between the two groups was statistically significant (p < 0.05), while no significant difference was observed for SAP and depression depth.

Conclusions: Of all the 140 cases in this study, 10.7 % are located in the posterolateral region. An appropriate operative approach and fixation method should be selected based on the individual morphological characteristics of lateral plateau fractures.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Radiographic measurements: in computed tomography (CT) transverse view. Two smaller figures showed the section and fracture. Point O and Point A: projections of the midpoint of two tibial intercondylar eminences and the most anterior point of tibial tuberosity. Point B: intersection of line AO and posterior edge. Point C: centre of articular depression region. In this case, the discontinuity arc is from 71° to 147°, the angle of depression centre (ADC) was 84°, the anterior-posterior position of depression centre (APDC) was 57 %, and the posterolateral cortex is broken
Fig. 2
Fig. 2
Radiographic measurements: in computed tomography (CT) sagittal and coronal view. In this case, the sagittal angulation was 11°, the depression depth was 10 mm
Fig. 3
Fig. 3
X ray and three dimensional computed tomography (CT) view of one case in intact posterolateral group. The split fracture and articular depression are in the anterolateral region and indicate a traditional approach
Fig. 4
Fig. 4
X ray and three dimensional computed tomography (CT) view of one case in broken posterolateral cortex group. The centre of articular depression is in the posterolateral region and a displaced posterolateral fragment can be seen (white arrow), which is difficult to reduce and fix by a traditional anterolateral approach
Fig. 5
Fig. 5
The scatterplots of articular depression centre. A: 140 cases. B: 69 cases of intact posterolateral wall. C: 71 cases of broken posterolateral cortex. D:47 cases have posterolateral fragment, and 15 centres in the posterolateral region
Fig. 6
Fig. 6
One case was classified as Schatzker type II fracture by X ray examination, but a fracture line in medial plateau (white arrow) was found under computed tomography (CT) scanning, and verified at operation
See this image and copyright information in PMC

Comment in

References

    1. Kennedy JC, Bailey WH. Experimental tibial-plateau fractures. Studies of the mechanism and a classification. J Bone Joint Surg Am. 1968;50(8):1522–1534. - PubMed
    1. Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B, Audigé L. Fracture and Dislocation Classification Compendium - 2007: Orthopaedic Trauma Association Classification, Database and Outcomes Committee. J Orthop Trauma. 2007;21(10 Su ppl):S1–S133. doi: 10.1097/00005131-200711101-00001. - DOI - PubMed
    1. Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968-1975. Clin Orthop Relat Res. 1979;138:94–104. - PubMed
    1. Zhu Y, Yang G, Luo CF, Smith WR, Hu CF, Gao H, Zhong B, Zeng BF. Computed tomography-based Three-Column Classification in tibial plateau fractures: introduction of its utility and assessment of its reproducibility. J Trauma Acute Care Surg. 2012;73(3):731–737. doi: 10.1097/TA.0b013e31825c17e7. - DOI - PubMed
    1. Karunakar MA, Egol KA, Peindl R, Harrow ME, Bosse MJ, Kellam JF. Split depression tibial plateau fractures: a biomechanical study. J Orthop Trauma. 2002;16(3):172–177. doi: 10.1097/00005131-200203000-00006. - DOI - PubMed