Tibia Plateau Fracture Down the Road: A Concise Review of Evolving Classifications

Pouya Tabatabaei Irani; Mohammad Ayati Firoozabadi; Seyed Hossein Jahan Bakhsh; Mehdi Bayati; Aidin Arabzade; Seyed Mohammad Javad Mortazavi

doi:10.18502/jost.v11i3.19401

Pouya Tabatabaei Irani Assistant Professor, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
Mohammad Ayati Firoozabadi Associate Professor, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
Seyed Hossein Jahan Bakhsh Resident, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
Mehdi Bayati Resident, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
Aidin Arabzade Assistant Professor, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
Seyed Mohammad Javad Mortazavi Professor, Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/jost.v11i3.19401

Keywords: Tibia; Classification; Trauma

Abstract

Tibial plateau fractures (TPFs) are complex intra-articular injuries that demand precise classification for optimal surgical planning and outcomes. Traditional systems such as Schatzker and AO Foundation/Orthopedic Trauma Association (AO/OTA) classifications have been instrumental in categorizing these fractures based on plain radiographic findings. However, they often fall short in accurately identifying posterior column involvement and coronal plane fractures. The advent of computed tomography (CT) imaging and three-dimensional (3D) reconstructions has led to the development of more precise classification systems, notably Luo’s three-column model. This review provides a comprehensive review of the Schatzker, AO/OTA, and three-column classifications, highlighting their principles, clinical utility, and limitations. The updated three-column concept (uTCC) further incorporates injury mechanisms by assessing posterior tibia slope and medial plateau angles, offering enhanced guidance for surgical approaches. Studies comparing these systems suggest that the three-column model provides superior interobserver reliability and preoperative planning utility, especially in identifying and managing posterior column injuries. This review underscores the evolution toward 3D and mechanism-based classifications to improve treatment strategies for TPFs.