Schatzker IV tibial plateau fractures: are they always unicondylar?

OBJECTIVE

The objectives of this study were to describe the incidence and morphology of medial tibial plateau fractures that extend into the lateral articular surface and to describe trends in their management.

DESIGN

Retrospective.

SETTING

Level I Urban Trauma Center.

PATIENTS

Seventy consecutive patients sustaining OTA/AO 41 B1 and B3 fractures.

INTERVENTION

Open reduction internal fixation of medial tibial plateau fractures.

MAIN OUTCOME MEASUREMENTS

Incidence of medial tibial plateau fractures that extend into the lateral articular surface. Secondary outcomes include localization of lateral articular surface depression, neurovascular injury, and trends in surgical management.

RESULTS

Seventy patients were included with 9 fractures (12.9%) isolated to the medial condyle (MC) and 61 fractures (87.1%) extending to the lateral condyle (LC). Compartment syndrome was present in 2 patients (2.9%), peroneal nerve palsy in 2 (2.9%), and arterial injury in 1 (1.4%). Initial external fixation was used more frequently in the LC group compared with the MC group ( = 0.028). Of the 61 fractures in the LC group, 49 (80.3%) included lateral articular surface depression which localized to the posteromedial quadrant of the lateral articular surface in 36 of 49 fractures (73.5%). Lateral articular surface depression depth ≥10.6 mm was associated with the use of dual incisions ( < 0.001).

CONCLUSIONS

Schatzker IV fractures frequently extend to the lateral condyle and often present with depression of the posteromedial lateral articular surface. Fractures with lateral articular surface depression depth ≥10.6 mm were more likely to undergo fixation with dual incisions.

LEVEL OF EVIDENCE

Therapeutic level IV.