Introduction of 3D-classification and its derived surgical sequence of Schatzker type IV tibial plateau fractures

Abstract

Introduction Schatzker IV tibial plateau fractures usually have worse prognosis due to its high variability and the combination of bony and soft tissue injuries. The aim of this study was to introduce a new classification of Schatzker IV tibial plateau fractures based on the injury mechanism and evaluate its reliability. The secondary aim was to evaluate the outcomes of operative Schatzker IV tibial plateau fractures treated according to the surgical sequences which were determined by the new classification. Materials and Methods 63 operative Schatzker IV tibial plateau fractures which were treated following the new surgical sequence were enrolled in our study. CT images of these patients were reviewed and classified twice according to our new classification by four observers. The reliability of the classification was calculated by application of kappa analysis. The surgical sequence determined by the classification was evaluated by observing the the postoperative efficacy during the follow-up. Results The intra-observer reliability of 3D-classification showed excellent agreement according to Landis and Koch (The mean k = 0.897, CI 0.806–0.971). And the inter-obsever reliability of 3D-classification also showed excellent agreement. (The mean k = 0.883, CI 0.786–0.961). All patients were followed up and the average follow-up of the cases was 12.8 months (6–28 months). As for the evaluation of the postoperative efficacy, according to KSS, 53 cases were rated as excellent, 8 cases were rated as good and 2 cases were considered as fair results. Conclusions The new proposed classification showed high intra and inter-observer reliability in our study. And the surgical sequence determined by the classification can help surgeons to acquire good reduction and rigid internal fixation. Therefore the new classification of Schatzker IV tibial plateau fractures and the accompanied surgical sequence are worthy of further popularization and application in clinical trials.