AbstractBackground: Tibial plateau fractures (TPFs) are complex intra-articular injuries of the proximal tibia that often result from high-energy trauma such as road traffic accidents. These fractures require precise classification and surgical planning to restore joint congruity and function. While the Schatzker classification system based on plain radiographs has traditionally guided management, computed tomography (CT)-based three-column classification has emerged as a more accurate tool, especially for identifying posterior column involvement.
Aim: To evaluate the radiological classification, column involvement, and clinical profile of patients with tibial plateau fractures using CT-based three-column and Schatzker classification systems and to correlate findings with the mechanism of injury and associated skeletal injuries.
Methods: A demographic observational study was conducted in the Department of Orthopaedics at Tata Main Hospital, Jamshedpur, from February 2019 to January 2020. One hundred patients with closed or Grade I open tibial plateau fractures were included. Fractures were classified using both Schatzker and CT-based three-column classification systems. Data were statistically analyzed using SPSS Version 21.0.
Results: Road traffic accidents accounted for 81% of injuries. Most fractures involved multiple columns, with 44% being bicolumnar and 42% tricolumnar. Schatzker type VI (38%) and type V (18%) were the most common fracture types. A significant association was found between Schatzker classification and number of columns involved (p < 0.0001). CT imaging was crucial in identifying posterior and complex fractures and influenced surgical planning. Additionally, 44% of patients had associated skeletal injuries, most commonly involving the fibula and patella.
Conclusion: CT-based three-column classification provides superior fracture mapping compared to traditional radiographic methods. It enhances diagnostic accuracy, guides appropriate surgical approaches, and correlates well with fracture complexity and mechanism of injury. Its routine use is recommended in the evaluation and management of tibial plateau fractures, particularly in high-energy trauma.
