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This patient can expect a poor functional outcome and significant sports activity limitations
25%
227/911
This fracture type is typically a result of a low mechanism injury
1%
10/911
This fracture type has the highest rate of meniscal injury
35%
315/911
Patients have higher satisfaction rates with surgical treatment of this fracture type
30%
277/911
This fracture is best classified using the Schatzker classification
8%
74/911
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This patient sustained a posterior column tibial plateau fracture as a result of a varus mechanism. Posterior plateau fractures, specifically as a result of varus mechanisms, have demonstrated poor outcomes and marked sports activity limitations (Answer 1). Tibial plateau fractures can present in a variety of morphologies. The direction of force and position of the knee at the time of injury determine the fracture pattern. Classically, the Schatzker classification is used for its simplicity and wide acceptance. However, this classification system does not adequately address fracture subtypes with significant sagittal deformities. Because of this, new attention has been given to fractures with posterior plateau deformities. Using the three-column classification (Illustration A), primarily based on CT, surgeons can better identify and classify posterior plateau fractures. Posterior column fractures, often addressed through a posterior approach, have been associated with poor functional outcomes relative to other column fractures. Van den Berg et al. performed a retrospective review on 145 posterior tibial plateau fractures treated operatively. Trauma mechanism and fracture morphology were evaluated to determine relationships to functional outcomes. The authors found that varus mechanism and delayed fixation led to worse clinical outcomes in posterior tibial plateau fractures. Quintens et al. performed a retrospective multicenter study on 51 patients with posterior column fractures of the tibial plateau treated operatively. The majority of the patients reported being very or slightly disappointed with their outcomes. Only 68.4% of patients were able to return to any level of sports activity. The authors concluded that tibial plateau fractures with posterior column involvement resulted in significant patient dissatisfaction and limitations in sports activity. Van den Berg et al. published a review article on posterior tibial plateau fractures in 2020. The authors evaluated the fracture morphology, trauma mechanism, and soft tissue integrity involved in these fractures. They highlight the importance of identifying and addressing these three factors when approaching posterior tibial plateau fractures. The authors concluded that posterior tibial plateau fractures are a large driver in poor outcomes and should garner greater attention. Figure A demonstrates a posterior column fracture of the tibial plateau. Illustration A demonstrates the three-column classification system for tibial plateau fractures. Incorrect Answers: Answer 2: Low energy mechanisms more commonly create lateral plateau fractures. Answer 3: Medial (Schatzker IV) and lateral (Schatzker II) plateau fractures have higher rates of meniscal injuries than posterior plateau fractures. Answer 4: Patients do not have a high satisfaction rate with posterior plateau fractures. Answer 5: The Schatzker classification system does not appropriately address this posterior tibial plateau fracture pattern.
1.9
(20)
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