Medial Tibial Plateau Fractures: a New Classification System

Abstract

Background: Fractures of the medial plateau are associated with significant soft tissue injuries. A predictive measure of which medial plateau fractures are at higher risk of associated injuries has not been described. The authors propose a simple classification that is both easy to remember, recognize, and predictive of associated injuries. A type A fracture is where the fracture line is medial to the intercondylar spines, a type B is where the fracture line is within the intercondylar spines, and a type C fracture is where the fracture line is lateral to the intercondylar spines. Methods: All patients treated at a Level I trauma center for tibial plateau fractures between 1998 and 2005 were identified. The radiographs of these patients were reviewed, and 28 patients were included in the study. The medical charts were then reviewed, and any associated injuries were noted. The patients were placed into one of three groups based on their fracture pattern. Results: Of the seven type A fractures, there was one patient with compartment syndrome (14%) and another with an ACL tear and medial meniscal tear. Of the 12 type B fractures, there were four patients with compartment syndrome (33%) and one with an ACL avulsion and medial meniscal tear. Of the nine type C fractures, there were six patients with compartment syndrome (67%), one of these also had a peroneal nerve injury, and another patient had an anterior tibial artery injury that required vascular surgery intervention. Conclusion: As the fracture line moves laterally the severity of the associated injuries increases. We think it is significant that the only neurologic and vascular injuries seen were in the type C fractures. Also, we noted an increase propensity for type C fractures to develop compartment syndrome. This information can be helpful during the initial evaluation of the patient so that the physician can be wary of these developing problems.