Ability of the Schatzker classification to predict posteromedial fragmentation in tibial plateau fractures

  • Heinrich G Niemoller Kalafong Hospital
  • P Greyling University of Pretoria
  • F Birkholtz Unitas Hospital
  • R Goller University of Pretoria
  • F Suleman University of Pretoria
  • T C Postma University of Pretoria
Keywords tibial plateau fracture, Schatzker classification, CT scan, posteromedial fragmentation

Abstract

Background: The Schatzker classification is the most widely accepted system used to classify tibial plateau fractures. The presence of posteromedial fragments in the more severe fracture types is known, but the presence of posteromedial fragmentation in the less severe fracture types is unknown. The ability of the Schatzker classification to predict posteromedial fragmentation was evaluated.


Methods: Two hundred patients were reviewed of which only 67 met the inclusion criteria. The X-rays were reviewed by three independent orthopaedic surgeons and classified according to the Schatzker classification. A radiologist reviewed the CT scans and noted the presence or absence of a posteromedial fragment and if present, the largest diameter of the fragment was measured. 


Results: The mean age of the sample was 44.79 (SD: 14.03) years. Seventy-five per cent of the females (n=33) presented with posteromedial fragmentation compared to 65.20% of the males (n=44) (chi²-test, P=0.399). The incidence of posteromedial fragmentation varied between 15.8 and 26.3% for Schatzker 1 and 2 fractures and 73.7 and 84.2% for Schatzker 3 to 6 (chi2-test, p<0.001) based on the three independent assessments. The mean length of the posteromedial fragmentation ranged from 41.87 to 47.77 mm for Schatzker 1 and 2 fractures, and 44.74 to 46.12 mm for Schatzker 3 to 6 for the three assessors (statistically not significant [T-test, P=0.536, P=0.551 and P=0.652]).


Conclusion: The Schatzker classification by itself is not adequate to identify all fractures with posteromedial fragmentation. There is a higher association of posteromedial fragmentation with fracture types 3 to 6. There is a high probability of missing a significantly sized posteromedial fragment in Schatzker type 1 and 2 fractures if a CT scan is not performed which might influence and compromise fracture stability, joint congruency and the ability to rehabilitate optimally.


Level of evidence: Level 4

Author Biographies

Heinrich G Niemoller, Kalafong Hospital

BSc(UV), MBBCh(Wits)

Orthopaedic surgeon in training

Kalafong Hospital

Pretoria

P Greyling, University of Pretoria

MBChB(Pret), MMed(Orth)(Pret), FCS(Orth)(SA)

Orthopaedic Surgeon

Steve Biko Academic Hospital

F Birkholtz, Unitas Hospital

MBChB(Pret), MMed(Orth)(Pret), FCS(Orth)(SA)

Orthopaedic Surgeon

Unitas Hospital

Walk-a-mile Centre of Excellence

R Goller, University of Pretoria

MBChB(Pret), MMed(Orth)(Pret), FCS(Orth)(SA)

Orthopaedic Surgeon

Steve Biko Academic Hospital

F Suleman, University of Pretoria

MBChB(Pret), MMed(Radiology)(Pret), FCS(Rad)(SA)

Radiologist

Professor

Steve Biko Academic Hospital

T C Postma, University of Pretoria

MChD, DHSM, PhD

Associate Professor and Head of Clinical Unit and Statistician

Orthopaedic Surgery

Department of Orthopaedic Surgery

Steve Biko Hospital

University of Pretoria

Published
2018-05-22
How to Cite
NIEMOLLER, Heinrich G et al. Ability of the Schatzker classification to predict posteromedial fragmentation in tibial plateau fractures. South African Orthopaedic Journal, [S.l.], p. 16-19, may 2018. ISSN 2309-8309. Available at: <http://journal.saoa.org.za/index.php/saoj/article/view/216>. Date accessed: 19 june 2018.