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



Irani PT ; Ayati Firoozabadi M ; Bakhsh SHJ ; Bayati M ; Arabzade A ; Mortazavi SMJ
Source: Journal of Orthopedic and Spine Trauma Published:2025

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. © 2025 Elsevier B.V., All rights reserved.