A 30-year-old cyclist has a tibial plateau fracture. CT scan shows a lateral plateau split-depression fracture with depression of 10 mm and a fragment involving 40% of the lateral plateau. Ligamentous instability is noted. Schatzker classification of this fracture is:

• A Schatzker Type I — pure split fracture lateral plateau
• B Schatzker Type III — pure depression fracture lateral plateau
• C Schatzker Type IV — medial plateau fracture
• D Schatzker Type II — split-depression fracture lateral plateau ✓

Explanation

The Schatzker classification of tibial plateau fractures: Type I (lateral split, no depression — young bone), Type II (lateral split-depression — commonest overall, in older bone), Type III (pure depression of lateral plateau, no split), Type IV (medial plateau fracture — associated with axial loading), Type V (bicondylar plateau), Type VI (plateau fracture with metaphyseal-diaphyseal dissociation). A split component plus articular depression on the lateral plateau = Type II. Surgical indication includes articular depression >5 mm (by most criteria), mechanical instability, or combined with ligament injury. ORIF with lateral buttress plate and bone graft/substitute for depression elevation is the standard.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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