Decoding tibial plateau fracture classifications: a century of individualized insights in a systematic review

We conducted a systematic review of all proposed classifications of tibial plateau fractures (TPFs) to facilitate comparison and identify the most effective reduction methods.

PubMed, Scopus, Embase, Web of Science and Cochrane Library databases were searched for all the articles involving the suggestion of a new method of TPF classification. The descriptions of classifications, along with their suggested management strategies, were recorded.

Out of the 2,712 identified records, 69 were included in the study. Schatzker's and Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classifications were the most frequently mentioned in the literature. The concept of a 'column' and posterior column fractures were introduced in 2010. Following this, posterior plateau fractures were further divided into posteromedial and posterolateral fractures. Proposed treatment approaches in most studies were based on the involved region and degree of displacement, while others considered fracture plane, deformity direction and type of fracture. The latest developments include the subclassification of the posterolateral column and consideration of associated injuries to the fibular head, eminentia, extensor mechanism and mechanical derangements along with the concept of the main deformity direction.

The understanding of TPF patterns, associated injuries, surgical approaches and fixation methods has evolved in a compelling stepwise manner. Currently, there is no gold standard classification that addresses fracture configuration, soft-tissue injuries, principal direction of deformity, central eminence avulsions, extensor mechanism disruptions and mechanical derangements, while maintaining a simple and reliable categorization. Therefore, employing individualized classification systems remains the most logical approach at present. This study offers invaluable assistance in this regard.