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Categorias
Reescritas a partir da fonte e citadas
I
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Type I
Lateral tibial plateau fracture without articular depression: a wedge-shaped, pure cleavage (vertical split) of the lateral plateau, typically a low-energy injury in younger patients with good bone quality.
CondutaMinimally displaced splits are managed nonoperatively (protected weight-bearing). Operative ORIF is indicated for significant displacement, articular step-off, condylar widening, or instability; lateral depression over ~6 mm or widening over ~5 mm raises concern for associated meniscal/ligament injury that should be addressed.
RiscoLower-energy pattern; soft-tissue injury risk rises with greater depression/widening. Lateral meniscal and ligament tears are associated, particularly as displacement increases.
verificadoThe tibial plateau fracture (Schatzker)Wikipedia 'Schatzker classification', Classification subsection (type definition); management and soft-tissue thresholds from StatPearls 'Tibial Plateau Fractures' (NBK470593), Treatment/Complications sections ('articular surface depression of more than 6mm and/or articular widening of more than 5 mm').
II
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Type II
Lateral tibial plateau fracture combining a cleavage split with depression of the articular surface; the most common type, usually low-energy.
CondutaNonoperative for minimally displaced/depressed fractures; ORIF (often with elevation of the depressed fragment, bone grafting/void filler, and buttress plating) for significant articular step-off, condylar widening, or instability.
RiscoMost commonly associated with lateral meniscal tears, especially when articular depression exceeds ~10 mm.
verificadoThe tibial plateau fracture (Schatzker)Wikipedia 'Schatzker classification', Classification subsection; management/associations from StatPearls NBK470593, Treatment and Complications sections ('Lateral meniscal tears... most common with Schatzker II... especially with depression >10mm').
III
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Type III
Focal/pure depression of the lateral (or central) articular surface with no associated split (pure compression); rare; tends to occur in older patients with weaker bone.
CondutaNonoperative if minimally depressed and the joint is stable; ORIF with elevation of the depressed segment and subchondral grafting/void filling when articular depression is significant or the joint is unstable.
RiscoRisk of articular incongruity and secondary instability; associated soft-tissue injury is less frequent than in split-depression patterns.
verificadoThe tibial plateau fracture (Schatzker)Wikipedia 'Schatzker classification', Classification subsection; management principles from StatPearls NBK470593, Treatment section (nonoperative for minimally displaced split or depression patterns; ORIF for significant step-off).
IV
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Type IV
Medial tibial plateau fracture, with or without depression; may involve the tibial spines. High-energy varus injury often representing a fracture-dislocation.
CondutaGenerally operative (ORIF); part of the IV/V/VI group for which surgery is recommended. Requires careful neurovascular assessment given the fracture-dislocation mechanism.
RiscoHigher rate of neurovascular injury (vascular injury common in IV fracture-dislocations); medial meniscus tears most common in this pattern; ACL injury reported in about a quarter of type IV and VI patterns.
verificadoThe tibial plateau fracture (Schatzker)Wikipedia 'Schatzker classification', Classification subsection; risks and operative indication from StatPearls NBK470593, Treatment/Complications ('Schatzker IV, V, and VI injuries' operative; 'ACL injuries... a quarter of Schatzker type IV and VI'; 'Vascular injury... common in Schatzker IV fracture-dislocations').
V
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Type V
Bicondylar fracture involving split of both the medial and lateral plateaus; high-energy combined varus/valgus mechanism.
CondutaOperative (ORIF), frequently with dual plating; staged management with temporary spanning external fixation may be used while soft tissues recover. Part of the IV/V/VI group for which surgery is recommended.
RiscoHigh-energy bicondylar injury carries substantial risk of compartment syndrome and significant soft-tissue compromise.
verificadoThe tibial plateau fracture (Schatzker)Wikipedia 'Schatzker classification', Classification subsection; operative indication from StatPearls NBK470593, Treatment section ('Schatzker IV, V, and VI injuries'); compartment syndrome noted as 'a devastating complication'.
VI
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Type VI
Tibial plateau fracture with metaphyseal-diaphyseal dissociation: a transverse subcondylar fracture separating the metaphysis from the diaphysis; high-energy, frequently open.
CondutaOperative; commonly staged with temporary spanning external fixation followed by definitive ORIF once soft tissues stabilize. Part of the IV/V/VI group for which surgery is recommended.
RiscoHigh-energy pattern with elevated risk of compartment syndrome, open injury, and neurovascular compromise; ACL injury reported in about a quarter of type IV and VI patterns.
verificadoThe tibial plateau fracture (Schatzker)Wikipedia 'Schatzker classification', Classification subsection; operative indication and risks from StatPearls NBK470593, Treatment/Complications ('Schatzker IV, V, and VI injuries' operative; compartment syndrome 'a devastating complication'; ACL injuries in 'a quarter of Schatzker type IV and VI fracture patterns').