Review Article

Tibia Plateau Fracture Down the Road: A Concise Review of Evolving Classifications

Abstract

Tibial plateau fractures (TPFs) are complex intra-articular injuries that demand precise classification for optimal surgical planning and outcomes. Traditional systems such as Schatzker and AO Foundation/Orthopedic Trauma Association (AO/OTA) classifications have been instrumental in categorizing these fractures based on plain radiographic findings. However, they often fall short in accurately identifying posterior column involvement and coronal plane fractures. The advent of computed tomography (CT) imaging and three-dimensional (3D) reconstructions has led to the development of more precise classification systems, notably Luo’s three-column model. This review provides a comprehensive review of the Schatzker, AO/OTA, and three-column classifications, highlighting their principles, clinical utility, and limitations. The updated three-column concept (uTCC) further incorporates injury mechanisms by assessing posterior tibia slope and medial plateau angles, offering enhanced guidance for surgical approaches. Studies comparing these systems suggest that the three-column model provides superior interobserver reliability and preoperative planning utility, especially in identifying and managing posterior column injuries. This review underscores the evolution toward 3D and mechanism-based classifications to improve treatment strategies for TPFs.

1. Millar SC, Arnold JB, Thewlis D, Fraysse F, Solomon LB. A systematic literature review of tibial plateau fractures: What classifications are used and how reliable and useful are they? Injury. 2018;49(3):473-90. doi: 10.1016/j.injury.2018.01.025. [PubMed: 29395219].
2. Hu YL, Ye FG, Ji AY, Qiao GX, Liu HF. Three-dimensional computed tomography imaging increases the reliability of classification systems for tibial plateau fractures. Injury. 2009;40(12):1282-5. doi: 10.1016/j.injury.2009.02.015. [PubMed: 19535056].
3. Kfuri M, Schatzker J. Revisiting the Schatzker classification of tibial plateau fractures. Injury. 2018;49(12):2252-63. doi: 10.1016/j.injury.2018.11.010. [PubMed: 30526924].
4. Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and Dislocation Classification Compendium-2018. J Orthop Trauma. 2018;32(Suppl 1):S1-s170. doi: 10.1097/bot.0000000000001063. [PubMed: 29256945].
5. Moore TM, Patzakis MJ, Harvey JP. Tibial plateau fractures: definition, demographics, treatment rationale, and long-term results of closed traction management or operative reduction. J Orthop Trauma. 1987;1(2):97-119. [PubMed: 3333518].
6. Zhu Y, Hu CF, Yang G, Cheng D, Luo CF. Inter-observer reliability assessment of the Schatzker, AO/OTA and three- column classification of tibial plateau fractures. J Trauma Manag Outcomes. 2013;7(1):7. doi: 10.1186/1752-2897-7-7. [PubMed: 24025650]. [PubMed Central: PMC3848575].
7. Luo CF, Sun H, Zhang B, Zeng BF. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma. 2010;24(11): 683-92. doi: 10.1097/BOT.0b013e3181d436f3. [PubMed: 20881634].
8. Zhu Y, Yang G, Luo CF, Smith WR, Hu CF, Gao H, et al. Computed tomography-based Three-Column Classification in tibial plateau fractures: introduction of its utility and assessment of its reproducibility. J Trauma Acute Care Surg. 2012;73(3):731-7. doi: 10.1097/TA.0b013e31825c17e7. [PubMed: 22929503].
9. El Kharboutly AMF. Multi-detector computed tomography assessment of the tibial plateau fractures. Egypt J Radiol Nucl Med. 2015;46(3):695-9. doi: 10.1016/j.ejrnm.2015.05.011.
10. Patange Subba Rao SP, Lewis J, Haddad Z, Paringe V, Mohanty K. Three-column classification and Schatzker classification: a three- and two-dimensional computed tomography characterisation and analysis of tibial plateau fractures. Eur J Orthop Surg Traumatol. 2014;24(7):1263-70. doi: 10.1007/s00590-013-1308-9. [PubMed: 24013813].
11. Wang Y, Luo C, Zhu Y, Zhai Q, Zhan Y, Qiu W, et al. Updated Three-Column Concept in surgical treatment for tibial plateau fractures - A prospective cohort study of 287 patients. Injury. 2016;47(7):1488-96. doi: 10.1016/j.injury.2016.04.026. [PubMed: 27211226].
12. Zhang BB, Sun H, Zhan Y, He QF, Zhu Y, Wang YK, et al. Reliability and repeatability of tibial plateau fracture assessment with an injury mechanism-based concept. Bone Joint Res. 2019;8(8): 357-66. doi: 10.1302/2046-3758.88.Bjr-2018-0331.R1. [PubMed: 31537993]. [PubMed Central: PMC6719528].
13. Hoekstra H, Kempenaers K, Nijs S. A revised 3-column classification approach for the surgical planning of extended lateral tibial plateau fractures. Eur J Trauma Emerg Surg. 2017;43(5):637-43. doi: 10.1007/s00068-016-0696-z. [PubMed: 27277073].
Files
IssueVol 11 No 3 (2025) QRcode
SectionReview Article
DOI https://doi.org/10.18502/jost.v11i3.19401
Keywords
Tibia Classification Trauma
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Tabatabaei Irani P, Ayati Firoozabadi M, Jahan Bakhsh SH, Bayati M, Arabzadeh A, Mortazavi SMJ. Tibia Plateau Fracture Down the Road: A Concise Review of Evolving Classifications. J Orthop Spine Trauma. 2025;11(3):89-94.