Classification of Tibial Plateau Fractures

A tibial plateau fracture classification system was developed in order to assess the degree of injury and the appropriate treatment for each type of fracture. Multiple tibial plateau fracture classification systems have been developed but the most widely accepted and used system is the Schatzker Classification System. It consists of six condyle fracture types classified by fracture pattern and fragment anatomy. Each increasing numeric fracture type denotes increasing severity. The severity correlates with the amount of energy and impact applied to the bone at the time of injury.

  • Type I- Split lateral plateau: This is a wedge-shaped pure cleavage fracture and involves a vertical split of the lateral tibial plateau. It is usually the result of a low energy injury in young individuals with normal bone mineralisation. May be caused by a valgus (force pushing the knee inwards) combined with axial loading. It is common to have a lateral tear to the meniscus.

a fracture of the lateral tibial plateau with a simple vertical split and no commonution

  • Type II - Split depression lateral plateau: This is a combined cleavage and compression fracture and involves vertical split of the lateral condyle combined with depression of the adjacent load bearing part of the condyle. Caused by a valgus force (pushing the knee inwards) on an axially loaded limb. This is a low energy injury typically a result of osteoporotic changes in bone and occurs most commonly in older patients. This is the most common classification of tibial plateau fracture.

a fracture of the lateral tibial plateau with a vertical split and commonution

  • Type III - Depression lateral plateau: This is a pure compression fracture of the lateral or central tibial plateau in which the articular surface of the tibial plateau is depressed. Central depressions are more stable than lateral or posterior. This is a low energy injury typically a result of osteoporotic changes in bone. This classification of fracture is extremely rare and can result in joint instability.

a fracture of the lateral tibial plateau with depression in the joint surface

  • Type IV – Medial plateau: This is a medial tibial plateau fracture with a split or depressed component. It is usually the result of a high energy injury and involves a varus force (pushing the knee outwards) with axial loading at the knee. Most commonly associated with neurovascular injury. May represent a reduced knee fracture-dislocation and subsequent ligament injuries are common. 

a fracture of the medial tibial plateau usually associated with a knee dislocation and neuro-vascular compromise

  • Type V - Bicondylar: These fractures consist of a split fracture of the medial and lateral tibial plateau. It is usually the result of a high energy injury with a pure axial load. May also include damage or injury to the anterior cruciate ligament and collateral ligaments. Generally a small amount of metaphyis remains attached to the joint.

a fracture of both medial and lateral tibial plateaus

  • Type VI - Plateau and metaphyseal-diaphyseal dissociation: The main feature of this type of fracture is a transverse subcondylar fracture with dissociation of the metaphysis from the diaphysis. This is a high energy injury involving complex varus and valgus forces. Often these types of fractures are accompanied by extensive soft tissue injuries and risk of compartment syndrome ( a painful condition where pressure within the muscles builds to dangerous levels).

a fracture of both medial and lateral tibial plateaus and tibial metaphysis

Osseointegration Group of AustraliaNorwest Advanced OrthopaedicsDrummoyne Advanced Specialty ServicesThe Sports & Arthritis Clinic NorwestNorwest Advanced Specialty Services