Schatzker classification

The Schatzker classification, from the Toronto series published in 1979, sorts tibial plateau fractures into six types. Types I to III are lateral and usually from lower energy. Types IV to VI are more often high-energy.

Type I: split of the lateral plateau, no depression.

Type II: split of the lateral plateau plus depression of the adjacent joint surface.

Type III: pure depression of the lateral plateau, rim intact.

Type IV: medial plateau fracture, split or depressed.

Type V: bicondylar fracture, with the metaphysis still in continuity with the shaft.

Type VI: metaphyseal-diaphyseal dissociation, with or without bicondylar involvement.

Surgery aims to restore the joint surface, the limb alignment and the stability of the knee, with fixation strong enough to start early movement. Depressed fragments (II and III) are elevated and supported, usually with a bone graft or substitute and a buttress. In high-energy injuries, check the soft tissues, the compartments and the neurovascular status first. One approach for a swollen, blistered knee is staged care: a knee-spanning external fixator on admission, then definitive fixation once the soft tissues allow. In one prospective series of 57 high-energy fractures, deep infection occurred in 5%, though there was no comparison group.

The classification describes the bone, not the skin or the knee. Ligament and meniscal injuries are common companions but are not part of it, and a medial plateau fracture can be a fracture-dislocation, so examine the ligaments and the distal pulses. The agreement is only moderate (kappa about 0.55 with radiographs plus CT), and the system misses fracture lines in the coronal plane, so CT is used to plan the approach.

Viva question: A 40-year-old has a swollen, blistered knee after a fall from height, and the X-ray shows a Schatzker VI. What is your plan?

Read more: Schatzker et al., Clin Orthop Relat Res, 1979 · Egol et al., J Orthop Trauma, 2005 · Doornberg et al., Injury, 2011 · Kabra et al., Eur J Orthop Surg Traumatol, 2023

Education only, not medical advice. Management depends on the patient and your local protocol.