Tibial plateau fracture classification: Difference between revisions

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! colspan="2" |Schatzker Classification
! colspan="2" |Schatzker Classification
|-
|-
|I
|Type I
|Extra-articular
|Lateral split fracture
|-
|-
|II
|Type II
|Extra-articular with [[ulnar fracture]]
|Lateral Split-depressed fracture
|-
|-
|III
|Type III
|Intra-articular into [[radiocarpal joint]]
|Lateral Pure depression fracture
|-
|-
|IV
|Type IV
|Intra-articular into [[radiocarpal joint]] with [[ulnar fracture]]
|Medial plateau fracture
|-
|-
|V
|Type V
|Intra-articular into [[radioulnar joint]]
|Bicondylar fracture
|-
|-
|VI
|Type VI
|Intra-articular into [[radioulnar joint]] with [[ulnar fracture]]
|Metaphyseal-diaphyseal disassociation
|}
|}
===Melone Classification===
* Melone classified [[distal radius fracture]] based on location.<ref name="pmid8479722">{{cite journal| author=Melone CP| title=Distal radius fractures: patterns of articular fragmentation. | journal=Orthop Clin North Am | year= 1993 | volume= 24 | issue= 2 | pages= 239-53 | pmid=8479722 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8479722  }} </ref><ref name="pmid6728444">{{cite journal| author=Melone CP| title=Articular fractures of the distal radius. | journal=Orthop Clin North Am | year= 1984 | volume= 15 | issue= 2 | pages= 217-36 | pmid=6728444 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6728444  }} </ref>
{| class="wikitable"
! colspan="3" |Melone Classification
|-
|I
| colspan="2" |Undisplaced, no or minimal [[comminution]]
|-
| rowspan="3" |II
| colspan="2" |[[Die punch fracture]] with moderate to severe [[displacement]]
|-
|A
|Reducible
|-
|B
|Irreducible
|-
|III
| colspan="2" |Spike fragment present
|-
|IV
| colspan="2" |Wide separation of intra-articular fragments
|-
|V
| colspan="2" |Explosion fracture with severe [[comminution]], transverse split and rotational [[displacement]]
|}


===Hohl and Moore Classification===
===Hohl and Moore Classification===
* Fernández classified [[distal radius fracture]] based on [[trauma]] mechanism.<ref name="pmid11778328">{{cite journal| author=Fernandez DL| title=Distal radius fracture: the rationale of a classification. | journal=Chir Main | year= 2001 | volume= 20 | issue= 6 | pages= 411-25 | pmid=11778328 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11778328  }} </ref>
* Hohl and Moore classification of tibial plateau fracture is useful for fracture dislocation,  fracture patterns that cannot be classified by Schatzker classification and fractures associated with knee instability.
{| class="wikitable"
{| class="wikitable"
! colspan="2" |Fernández Classification
! colspan="2" |Hohl and Moore Classification
|-
|-
|Type 1
|Type I
|Bending [[Bone fracture|fracture]] of [[metaphysis]]
|Coronal split fracture
|-
|-
|Type 2
|Type II
|Shearing [[Bone fracture|fracture]] of joint surface
|Entire condylar fracture  
|-
|-
|Type 3
|Type III
|Compression [[Bone fracture|fracture]] of joint surface
|Rim avulsion fracture of lateral plateau
|-
|-
|Type 4
|Type IV
|Avulsion [[Bone fracture|fractures]] or [[radiocarpal]] [[fracture-dislocation]]
|Rim compression fracture
|-
|-
|Type 5
|Type V
|Combined [[Bone fracture|fractures]] associated with high high-velocity injuries
|Four-part fracture
|}
|}


===Universal Classification===
===Luo's Three Column Classification===
* Cooney classified [[distal radius fracture]] based on location and [[stability]].<ref name="pmid8479719">{{cite journal| author=Cooney WP| title=Fractures of the distal radius. A modern treatment-based classification. | journal=Orthop Clin North Am | year= 1993 | volume= 24 | issue= 2 | pages= 211-6 | pmid=8479719 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8479719  }} </ref>
* Luo's classified tibial plateau fracture based on computed tomography ‘‘three column fixation’’ concept which aided in  column-specific fixation technique.
{| class="wikitable"
{| class="wikitable"
! colspan="3" |Universal Classification
! colspan="2" |Luo's Three Column Classification
|-
|-
|Type 1
|Zero-column fracture
| colspan="2" |Extra-articular [[Bone fracture|fracture]], without deviation
|Pure articular depression
|-
|-
| rowspan="4" |Type 2
|1 Column fracture
| colspan="2" |Extra-articular [[Bone fracture|fracture]], with deviation
|Lateral column fracture
|-
|-
|2A
|2 Column fracture
|Reducible and stable
|Lateral and posterior column fracture
|-
|-
|2B
|3 Column  fracture
|Reducible and unstable
|Bicondylar fracture dividing into three fragments
|-
|2C
|Irreducible
|-
|Type 3
| colspan="2" |Intra-articular [[Bone fracture|fracture]], without deviation
|-
| rowspan="4" |Type 4
| colspan="2" |Intra-articular [[Bone fracture|fracture]], with deviation
|-
|4A
|Reducible and stable
|-
|4B
|Reducible and unstable
|-
|4C
|Irreducible
|}
|}
 
*
===OTA System===
===OTA System===
*AO/ASIF  classification is the widely accepted classification.  
*AO/ASIF  classification is the widely accepted classification.  
*[[Radius (bone)|Radius]] is given the number 21 based on the classification.<ref name="pmid25042062">{{cite journal| author=Arealis G, Galanopoulos I, Nikolaou VS, Lacon A, Ashwood N, Kitsis C| title=Does the CT improve inter- and intra-observer agreement for the AO, Fernandez and Universal classification systems for distal radius fractures? | journal=Injury | year= 2014 | volume= 45 | issue= 10 | pages= 1579-84 | pmid=25042062 | doi=10.1016/j.injury.2014.06.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25042062  }} </ref>
*Proximal tibia is given the number 41 based on the classification.
*It is further subdivided as:
*It is further subdivided as:
{| class="wikitable"
{| class="wikitable"
Line 137: Line 91:
|-
|-
|A1
|A1
|[[Ulnar fracture]], [[Radius (bone)|radius]] intact
|Avulsion
|-
|-
|A2
|A2
|[[Radius fracture]], simple and impacted
|Metaphyseal simple
|-
|-
|A3
|A3
|[[Radius fracture]], multifragmentary
|Metaphyseal multifragmentary
|-
|-
| rowspan="4" |B
| rowspan="4" |B
Line 149: Line 103:
|-
|-
|B1
|B1
|[[Radius fracture]], sagittal
|Pure split
|-
|-
|B2
|B2
|[[Radius fracture]], frontal, dorsal rim
|Pure depression
|-
|-
|B3
|B3
|[[Radius fracture]], frontal, volar rim
|Split depression
|-
|-
| rowspan="4" |C
| rowspan="4" |C
Line 169: Line 123:
|Articular multifragmentary
|Articular multifragmentary
|}
|}


==References==
==References==

Revision as of 21:28, 1 February 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

Overview

There are multiple classifications available for tibial plateau fracture. The most common classification systems for tibial plateau fracture include Schatzker, Hohl and Moore, Luo's three column concept and AO classification.

Classification

There are multiple classifications available for tibial plateau fracture. The most common classification systems for tibial plateau fracture include Schatzker, Hohl and Moore, Luo's three column concept and AO classification.

Schatzker Classification

Schatzker Classification of tibial plateau fracture. Source: Case courtesy of Case courtesy of Dr Sachintha Hapugoda, Radiopaedia.org, rID: 51744
  • Schatzker classification is the most commonly used classification for tibial plateau fracture.
Schatzker Classification
Type I Lateral split fracture
Type II Lateral Split-depressed fracture
Type III Lateral Pure depression fracture
Type IV Medial plateau fracture
Type V Bicondylar fracture
Type VI Metaphyseal-diaphyseal disassociation

Hohl and Moore Classification

  • Hohl and Moore classification of tibial plateau fracture is useful for fracture dislocation, fracture patterns that cannot be classified by Schatzker classification and fractures associated with knee instability.
Hohl and Moore Classification
Type I Coronal split fracture
Type II Entire condylar fracture
Type III Rim avulsion fracture of lateral plateau
Type IV Rim compression fracture
Type V Four-part fracture

Luo's Three Column Classification

  • Luo's classified tibial plateau fracture based on computed tomography ‘‘three column fixation’’ concept which aided in column-specific fixation technique.
Luo's Three Column Classification
Zero-column fracture Pure articular depression
1 Column fracture Lateral column fracture
2 Column fracture Lateral and posterior column fracture
3 Column fracture Bicondylar fracture dividing into three fragments

OTA System

  • AO/ASIF classification is the widely accepted classification.
  • Proximal tibia is given the number 41 based on the classification.
  • It is further subdivided as:
OTA System
A Extra-articular fractures
A1 Avulsion
A2 Metaphyseal simple
A3 Metaphyseal multifragmentary
B Partial articular fractures
B1 Pure split
B2 Pure depression
B3 Split depression
C Complete articular fractures
C1 Articular simple + metaphyseal simple
C2 Articular simple, metaphyseal multifragmentary
C3 Articular multifragmentary

References

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