Tibial plateau fracture classification: Difference between revisions

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{{Tibial plateau fracture}}
{{Tibial plateau fracture}}


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==Overview==
==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.
There are multiple [[Classification|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==
==Classification==
 
There are multiple [[Classification|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/OTA [[classification]].<ref>{{cite book | last = Rockwood | first = Charles | title = Rockwood and Green's fractures in adults | publisher = Wolters Kluwer Health/Lippincott Williams & Wilkins | location = Philadelphia, PA | year = 2010 | isbn = 9781605476773 }}</ref><ref>{{cite book | last = Azar | first = Frederick | title = Campbell's operative orthopaedics | publisher = Elsevier | location = Philadelphia, PA | year = 2017 | isbn = 9780323374620 }}</ref>
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===
*Schatzker classifiis the most commonly used classification for tibial plateau fracture.  
{| align="right"
|
[[File:Schatzker-classification-diagram.jpg|400px|thumb|none|Schatzker Classification of tibial plateau fracture. [https://radiopaedia.org/articles/schatzker-classification-of-tibial-plateau-fractures-1?lang=us Source: Case courtesy of Case courtesy of Dr Sachintha Hapugoda, Radiopaedia.org, rID: 51744]]]
|}


{| class="wikitable"
*Schatzker classification is the most commonly used classification for tibial plateau fracture.<ref name="pmid445923">{{cite journal| author=Schatzker J, McBroom R, Bruce D| title=The tibial plateau fracture. The Toronto experience 1968--1975. | journal=Clin Orthop Relat Res | year= 1979 | volume=  | issue= 138 | pages= 94-104 | pmid=445923 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=445923  }} </ref>
! colspan="2" |Schatzker Classification
|-
|I
|Extra-articular
|-
|II
|Extra-articular with [[ulnar fracture]]
|-
|III
|Intra-articular into [[radiocarpal joint]]
|-
|IV
|Intra-articular into [[radiocarpal joint]] with [[ulnar fracture]]
|-
|V
|Intra-articular into [[radioulnar joint]]
|-
|VI
|Intra-articular into [[radioulnar joint]] with [[ulnar fracture]]
|}


===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"
{| class="wikitable"
! colspan="3" |Melone Classification
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Schatzker Classification
|-
|-
|I
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |Type I
| colspan="2" |Undisplaced, no or minimal [[comminution]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Lateral split [[Bone fracture|fracture]]
|-
|-
| rowspan="3" |II
| style="background: #4479BA; color: #FFFFFF; text-align: center;" | Type II
| colspan="2" |[[Die punch fracture]] with moderate to severe [[displacement]]  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Lateral Split-depressed [[Bone fracture|fracture]]
|-
|-
|A
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |Type III
|Reducible
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Lateral Pure depression [[Bone fracture|fracture]]
|-
|-
|B
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |Type IV
|Irreducible
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Medial plateau [[Bone fracture|fracture]]
|-
|-
|III
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |Type V
| colspan="2" |Spike fragment present
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Bicondylar [[Bone fracture|fracture]]
|-
|-
|IV
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |Type VI
| colspan="2" |Wide separation of intra-articular fragments
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Metaphyseal-diaphyseal [[Dissociation (chemistry)|dissociation]]  
|-
|V
| colspan="2" |Explosion fracture with severe [[comminution]], transverse split and rotational [[displacement]]
|}
|}


{| align="left"
===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 [[Instability|knee instability]].<ref>Hohl M, Moore TM. Articular fractures of the proximal tibia. In: Evarts CM, editor. Surgery of the musculoskeletal system. 2nd ed., New York: Churchill Livingstone; 1990. </ref>
[[File:Schatzker-classification-diagram.jpg|200px|thumb|none|Schatzker Classification of tibial plateau fracture. [https://radiopaedia.org/articles/schatzker-classification-of-tibial-plateau-fractures-1?lang=us Source: Case courtesy of Case courtesy of Dr Sachintha Hapugoda, Radiopaedia.org, rID: 51744]]]
|}


===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>
{| class="wikitable"
{| class="wikitable"
! colspan="2" |Fernández Classification
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Hohl and Moore Classification
|-
|-
|Type 1
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |Type I
|Bending [[Bone fracture|fracture]] of [[metaphysis]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Coronal split [[fracture]]
|-
|-
|Type 2
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |Type II
|Shearing [[Bone fracture|fracture]] of joint surface
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Entire condylar [[Bone fracture|fracture]]  
|-
|-
|Type 3
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |Type III
|Compression [[Bone fracture|fracture]] of joint surface
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Rim avulsion [[Bone fracture|fracture]] of lateral plateau
|-
|-
|Type 4
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |Type IV
|Avulsion [[Bone fracture|fractures]] or [[radiocarpal]] [[fracture-dislocation]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Rim compression [[Bone fracture|fracture]]
|-
|-
|Type 5
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |Type V
|Combined [[Bone fracture|fractures]] associated with high high-velocity injuries
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Four-part [[Bone fracture|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 [[Classification|classified]] tibial plateau fracture  based on [[computed tomography]] ‘‘three column fixation’’ concept which aided in  column-specific [[fixation]] technique.<ref name="pmid20881634">{{cite journal| author=Luo CF, Sun H, Zhang B, Zeng BF| title=Three-column fixation for complex tibial plateau fractures. | journal=J Orthop Trauma | year= 2010 | volume= 24 | issue= 11 | pages= 683-92 | pmid=20881634 | doi=10.1097/BOT.0b013e3181d436f3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20881634 }} </ref>
 
{| class="wikitable"
{| class="wikitable"
! colspan="3" |Universal Classification
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Luo's Three Column Classification
|-
|-
|Type 1
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |Zero-column fracture
| colspan="2" |Extra-articular [[Bone fracture|fracture]], without deviation
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Pure articular depression
|-
|-
| rowspan="4" |Type 2
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |1 Column fracture
| colspan="2" |Extra-articular [[Bone fracture|fracture]], with deviation
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Lateral column [[Bone fracture|fracture]]
|-
|-
|2A
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |2 Column fracture
|Reducible and stable
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Lateral and posterior column [[Bone fracture|fracture]]
|-
|-
|2B
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |3 Column  fracture
|Reducible and unstable
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Bicondylar [[Bone fracture|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 also a widely accepted [[classification]].<ref>ME Muller, S Nazarian, P Koch. Classification AO des fractures. 1 Les os longs. Springler-Verlag, Berlin, 1987.</ref>  
*[[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"
! colspan="3" |OTA System
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |OTA System
|-
|-
| rowspan="4" |A
| rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |A
| colspan="2" |Extra-articular fractures
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |Extra-articular [[Bone fracture|fractures]]
|-
|-
|A1
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |A1
|[[Ulnar fracture]], [[Radius (bone)|radius]] intact
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Avulsion
|-
|-
|A2
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |A2
|[[Radius fracture]], simple and impacted
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Metaphyseal simple
|-
|-
|A3
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |A3
|[[Radius fracture]], multifragmentary
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Metaphyseal multifragmentary
|-
|-
| rowspan="4" |B
| rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |B
| colspan="2" |Partial articular fractures
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |Partial articular [[Bone fracture|fractures]]
|-
|-
|B1
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |B1
|[[Radius fracture]], sagittal
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Pure split
|-
|-
|B2
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |B2
|[[Radius fracture]], frontal, dorsal rim
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Pure depression
|-
|-
|B3
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |B3
|[[Radius fracture]], frontal, volar rim
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Split depression
|-
|-
| rowspan="4" |C
| rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |C
| colspan="2" |Complete articular fractures
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |Complete articular [[Bone fracture|fractures]]
|-
|-
|C1
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |C1
|Articular simple + [[metaphyseal]] simple
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Articular]] simple + [[metaphyseal]] simple
|-
|-
|C2
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |C2
|Articular simple, [[metaphyseal]] multifragmentary
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Articular]] simple, [[metaphyseal]] multifragmentary
|-
|-
|C3
| style="background: #4479BA; color: #FFFFFF; text-align: center;" |C3
|Articular multifragmentary
| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Articular]] multifragmentary
|}
|}


==References==
==References==
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[[Category:Orthopedics]]
[[Category:Orthopedics]]
[[Category:Orthopedic surgery]]
[[Category:Orthopedic surgery]]
[[Category:Primary care]]
[[Category:Fractures]]
[[Category:Fractures]]
[[Category:Bone fractures]]
[[Category:Bone fractures]]

Latest revision as of 00:25, 30 July 2020

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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/OTA classification.[1][2]

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.[3]
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 dissociation

Hohl and Moore Classification

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 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

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

  1. ↑ Rockwood, Charles (2010). Rockwood and Green's fractures in adults. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 9781605476773.
  2. ↑ Azar, Frederick (2017). Campbell's operative orthopaedics. Philadelphia, PA: Elsevier. ISBN 9780323374620.
  3. ↑ Schatzker J, McBroom R, Bruce D (1979). "The tibial plateau fracture. The Toronto experience 1968--1975". Clin Orthop Relat Res (138): 94–104. PMID 445923.
  4. ↑ Hohl M, Moore TM. Articular fractures of the proximal tibia. In: Evarts CM, editor. Surgery of the musculoskeletal system. 2nd ed., New York: Churchill Livingstone; 1990.
  5. ↑ Luo CF, Sun H, Zhang B, Zeng BF (2010). "Three-column fixation for complex tibial plateau fractures". J Orthop Trauma. 24 (11): 683–92. doi:10.1097/BOT.0b013e3181d436f3. PMID 20881634.
  6. ↑ ME Muller, S Nazarian, P Koch. Classification AO des fractures. 1 Les os longs. Springler-Verlag, Berlin, 1987.

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