The Schatzker classification system

After x rays confirm that you have a fractured tibial plateau, the next step for the surgeon will be answering the questions, “How severe is the fracture?” and “What type of fracture is it?” Surgeons use a classification system to grade the degree of injury, formulate a surgical plan and arrive at a likely prognosis (outcome). The most widely used system in Australia and the USA is the Schatzker classification system. It is composed of six condyle fracture types classified by the bone fracture pattern and the displacement of the bone fragments. Here we go… more bloody jargon!

A condyle is the round prominence at the end of a bone. In the tibia there are two at the top behind your kneecap – the medial and lateral condyles, both of which can be fractured. The lateral is on the outside of the right knee and the medial is on the inside of the right knee. There you go that wasn’t too hard was it? And it wasn’t even Latin. Condyle is from an old Greek word meaning “knuckle”. Bloody doctors! I fractured my lateral condyle.

Under the Schatzker system, each increasing number denotes increasing force trauma and severity. The severity correlates with the amount of energy imparted to the bone at the time of injury. The most common type of Schatzker classification in skiing are type 1 and type 11 injures. These are relatively minor. I suffered a type 11 fracture, very typical of a skiing accident.

Schatzker classification for tibial plateau fracture:

Type I = Lateral Tibial plateau fracture without depression.
This is a wedge-shaped cleavage break and involves a vertical split of the lateral tibial plateau. It is a low energy injury. It’s caused by a valgus force combined with axial loading (ie a downwards force along the line of your body). It’s the top half of your body smashing into the bottom half, that leads to the lateral condyle in the femur (bone in your upper leg) being driven into the articular surface of the tibial plateau at the top of your lower leg. Ouch! This represents about 6% of all tibial plateau fractures.

Type II = Lateral tibial plateau fracture with depression,
Yea! This is me! This is a combined cleavage and compression break and involves a vertical split of the lateral condyle combined with depression of the adjacent load bearing part of the condyle. This is also caused by a valgus force on the knee; it is classed as a low energy injury, but doesn’t feel like it when you hit the snow and your leg breaks. This is the most common form of tibial plateau fracture and makes up 75% of all tibial plateau fractures. There is a risk of injuries to the medial collateral ligament (MCL) in this type of break as the joint opens up and stretches the ligament as you impact the snow. You may also suffer damage to the anterior cruciate ligament (ACL).I strained, but did not tear my MCL. Hurt like hell for about 2 months after the injury. However, this is one of the the things that really went right for me. Trying to do rehab with a broken leg and a torn ACL or MCL would be just a huge pain in the arse!

I wont go on. You don’t want to know about types III, IV, V and VI. Very unpleasant especially type VI! You are unlikely to experience the joys of these fractures in skiing so lets stay on topic.

Important: Your surgeon will not tell you what classification of fracture you have. I used my x-rays and a medical textbook to decide that I had a Type II fracture. I confirmed this with my surgeon the day before I was operated on. I find it curious that surgeons don’t articulate the classification of the break, when discussing surgery with a patient. The classification system is vital in you making a decision about whether to have surgery or not and it will guide the surgeon in the type of treatment he undertakes e.g. I had a Type II vertical fracture of the lateral condyle with a 4mm depression of the adjacent tibial plateau surface. If this had been a 2mm or 3 mm depression I probably would not have been operated on. In Canada, a 4 mm depression is marginal and can go either way. 5mm and above and you will virtually always require surgery. Don’t take any bullshit from your doctor about the exact type of break you have. Keep at the surgeon until he goes through the exact classification with you and if he won’t, get another surgeon.

The following will not help your recovery in any way!

You don’t need to know but I thought I might tell you anyway, why it’s called the Schatzker classification system. Dr. Joseph Schatzker is known internationally for his expertise in trauma and fracture management and because in 1979 he published a groundbreaking book detailing how to classify broken tibial plateaus into various grades. He suggested these grades should be used as the basis for deciding the appropriate treatment. Dr. Schatzker’s book was called “The Rationale of Operative Fracture Management”. He sounds pretty smart to me. I wonder if he has ever broken his leg?