Kfuri and Schatzker classification of tibial plateau fractures

The Kfuri and Schatzker classification of tibial plateau fractures is a revision of the classic Schatzker classification ¹. It complements the original radiographic classification with the inclusion of CT, allowing for a tridimensional interpretation of the fracture ^2,3.

The revisited classification is proposed to present a better guide to the management of these fractures ^2,3.

Interpretation

The concepts of the virtual equator and the main wedge plane are necessary for the interpretation of the Kfuri-Schatzker classification.

Virtual equator of the tibial plateau

The virtual equator of the tibial plateau is defined by a plane intersecting the insertion of the fibular collateral ligament on the lateral tubercle of the fibular head and the posterior aspect of the insertion of the superficial medial collateral ligament ².

The virtual equator divides the medial and lateral axial columns into four quadrants.

Main wedge plane

To determine the main plane of a wedge in a tibial plateau fracture, one must identify the points where the articular rim and the metaphysis are breached. These points are marked with lowercase letters and determine the vertices of the wedge plane. The points where the wedge bisects the articular rim of the tibial plateau are marked with an "a" if anterior to the virtual equator and with a "p" if posterior to it. The point where the fracture exits at the metaphyseal area is denoted as "x", which could be anterior (a_x) or posterior (p_x) to the virtual. These three points establish the main fracture plane ².

A fracture may have one or more wedges, which can be in different planes.

Classification

The classification starts with the classic Schatzker classification, then adds modifiers depending on the location of the main plane of the wedge or wedges ^2,3:

• type I: lateral split wedge tibial plateau fracture

  • type I A: main wedge plane is anterior to the virtual equator

  • type I P: main wedge plane is posterior to the virtual equator

  • type I A + P: there are at least two distinct planes, with one anterior and one posterior to the virtual equator

• type II: lateral split wedge depression

  • type II A: main wedge plane is anterior to the virtual equator

  • type II P: main wedge plane is posterior to the virtual equator

  • type II A + P: there are at least two distinct planes, with one anterior and one posterior to the virtual equator

• type III: pure lateral depression

  • type III A: area of the depression is anterior to the virtual equator

  • type III P: area of the depression is posterior to the virtual equator

  • type III A + P: there are at least two distinct areas of the depression, with one anterior and one posterior to the virtual equator

• type IV: unicondylar medial tibial plateau fracture

  • type IV A: main wedge plane is anterior to the virtual equator

  • type IV P: main wedge plane is posterior to the virtual equator

  • type IV A + P: there are at least two distinct planes, with one anterior and one posterior to the virtual equator

Types V and VI are bicondylar fractures ^1-3. For these, the modifiers will indicate which of the four quadrants contain a main wedge plane. The quadrants are: anterolateral (AL), anteromedial (AM), posterolateral (PL), and posteomedial (PM).

• type V: bicondylar tibial plateau fracture

  • the most common variation of these is a type V AL + PM ³

• type VI: bicondylar tibial plateau fracture with shaft dissociation

  • multiple presentations are possible depending on which quadrants have been disrupted

See also

• tibial plateau fractures

• Schatzker classification of tibial plateau fractures