R3 Journal (@r3journal.bsky.social)

When it comes to tibial plateau fractures, structure matters. This R3 Pictorial Essay explores how radiologists can better support surgical decisions using modern classification systems. r3journal.org/doi/10.2214/...

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Slicing Through the Tibial Plateau: How Classification of Tibial Plateau Fractures Impacts Communication | AJR Tibial plateau fractures present a unique set of challenges for both radiologists and orthopedic surgeons, requiring effective communication to tailor surgical planning on a case-by-case basis. This article explores common classification systems for tibial plateau fractures, including the Schatzker, Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (AO/OTA), and three-column systems. Although the Schatzker classification system has been widely used since 1974 due to its easily recognizable fracture patterns, it fails to account for involvement of the posterior aspect of the tibial plateau, which can impact surgical decision-making. The AO/OTA classification system provides a detailed description of fracture morphology; however, it suffers from high interobserver variability and overlooks the posterior tibial plateau due to its reliance on anteroposterior imaging. The more recently developed three-column classification system addresses these limitations by using CT to address posterior column fractures, resulting in more comprehensive surgical planning. Understanding tibial plateau fractures from an orthopedic surgeon’s perspective, and clearly communicating all relevant information, is essential for radiologists to assist in preoperative planning. https://r3journal.org/doi/10.2214/R3J.24.01050