![]() ‘AO or Schatzker? How reliable is classification of tibial plateau fractures?’. CORR No 105, Nov-Dec 1974 220-239).ĪO/OTA developed a classification that is apparently more reliable in terms of intra- and inter- observer reliability than Shatzker’s classification (Walton et al 2003. Schatzker developed these ideas and came up with a 6-type classification system that is widely used (Shatzker J ‘Compression in the surgical treatment of fractures of the tibia’. Nearly half regained normal or near-normal range of motion. Unsurprisingly, the split or mildly comminuted cases had the best results the ones whose articular surfaces had been rendered into a mosaic of small fragments did worst. 2, May 1951, p160-166) classified these injuries into split, depression, and T or Y fractures. To what extent they affect prognosis is a moot point. ![]() I think the ones that follow are the best-known and most useful when planning treatment. Most do not tick enough of the boxes above as far as I’m concerned, and I’m going to mention just a few. There is a plethora of PTF classifications. represents a lingua franca for most orthopaedic surgeons. If the X-ray is negative, but you seriously suspect fracture, consider MRI.īeing naturally a ‘lumper’ rather than a ‘splitter’ as far as classifications are concerned, I prefer a classification that is: Tank et al, 2013 (DOI:) found the PKR to be equally sensitive to the Ottawa Knee Rules (0.86), but more specific at 0.51, versus 0.27 for the OKR.Īs always, with occult tibial fractures, the key to diagnosis is suspicion. The rules suggest X-ray after a blunt trauma or fall if: age 50 & the patient is unable to take 4 full weight-bearing steps on a flat foot. I shall briefly digress onto the Pittsburgh Knee Rules, formulated by Dr Seaberg. Unfortunately, in 53% of these missed cases, fracture position had worsened by the time of diagnosis a significant disability compensation was granted in 36% of cases due to delayed diagnosis (totalling 841,000 euros). 50 of 79 patients in whom X-ray was not done, were in fact candidates for X-ray according to the rules. In 53 cases the fracture had not been diagnosed on radiographs, even though in 84% of these the fracture was visible or suspected in retrospect. Only 42% had been evaluated using the PKRs. These authors reviewed 137 patients with delayed diagnosis of a fracture within the knee after trauma, to see if using the Pittsburgh Knee Rules (PKRs) could have reduced the number of TPFs that went undiagnosed. BMC Musculoskeletal Disorders (2018) 19:244 (Bear in mind the analgesic effect of alcohol or other unofficial or official medications). The patient may be able to partially weight bear through the limb, but usually not fully, and not for long. ![]() The amount of trauma necessary to cause the fracture is proportionate to bone quality perhaps a tackle in a young footballer, a fall from standing height in a grandmother. These usually present after relatively minor trauma as a painful joint with an effusion, which may be a small effusion to start with. They range from the invisible occult fracture (where the only challenge is diagnosis), right through to a technically-challenging multi-fragmentary nightmare that will give you almost as many flashbacks as the poor patient. Tibial plateau fractures (TPF) illustrate the concept of ‘fracture personality’ very well. ![]()
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