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So in this section we'll be talking a bit about

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tibial plateau fractures.

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So when we look at the tibial plateau from the top here,

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we can separate it into columns.

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We have a medial column, a lateral column,

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and posterior column.

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And then we can also take that surface

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and divide it into different quadrants.

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And so this diagram

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of the tibial plateau outlines those anatomic landmarks

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that delineate the medial, lateral

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and posterior columns, as well as the subdivisions

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of each column, including that a**l medial anterolateral,

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posterior medial and posterolateral.

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So with tibial plateau fractures, there are a number

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of classification schemes.

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One that's typically used

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by orthopedic surgeons is this Shaka classification.

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So the Shaka classification breaks it into six categories

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as shown in the diagrams here,

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and it goes from simple, relatively non-displaced fractures

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all the way through communed and displaced

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and multi column fractures.

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So the shaki classification system divides the tibial

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plateau fractures into six types.

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So in the type one you have this wedge-shaped pure cleavage

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fracture of the lateral tibial plateau, originally defined

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as having less than four millimeters of depression

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of the articular surface or displacement of the fragments.

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In Shaka two, there's a splitting

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and depression of the lateral tibial plateau.

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Namely, it's a type one fracture,

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but now with a depressed component

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and may have some combintion.

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This is generally considered the most common type

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chakra three is a pure depression

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of the lateral tibial plateau,

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but divided into two subtypes,

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whether it involves only lateral depression

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or if there's also some central depression of

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that intercondylar region.

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In a Chaska four, there's a medial tibial plateau fracture

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with a split or depressed component.

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In type five, you have a wedge fracture of both the lateral

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and medial tibial plateaus.

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And in type six there is a transverse tibial metaphyseal

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fracture along with any type of tibial plateau fracture.

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So it generates this metaphyseal difficile discontinuity.

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Now another system that was introduced in 2010

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is this three column fracture for tibial plateaus.

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So as shown on that previous diagram, we can have one

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that involves just the articular surface of the plateau,

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which would not be considered an entire column.

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So that would be a zero column fracture,

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but you would still want to be concerned about the degree

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of depression, particularly more than four millimeters.

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If it goes from one surface of the bone

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to the other involving a single column, then

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that's a one column fracture.

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So example here of a lateral tibial plateau fracture

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Line going from the articular surface into the metaphysis

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or meta dile region here.

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And it does not involve the central part of the spines,

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whereas a two column fracture would involve both the plateau

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and potentially going more centrally.

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And then a three column fracture

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where you have both medial lateral and the central

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or posterior column involved.

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So you can try

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to translate the three column system into the SHAS

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classification, and that's shown in the table here,

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which I'll leave for reference.

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However, the key take home points are there are certain

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tibial plateau fracture morphologies that are indications

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or more likely indications for surgery.

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So this is the reduced list of key findings, uh,

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that a radiologist should make for tibial plateau fractures.

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So looking at meta fassil difficile fracture displacement

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greater than a centimeter

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that is greater than 10 millimeters,

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having some angular deformity, whether it's in the coronal

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or sagittal plane of greater than 10 degrees

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articular surface depression

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or intraarticular displacement

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of greater than a few millimeters.

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So typically, or originally described as four millimeters,

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but some surgeons may do reductions less than that.

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So you can measure the exact amount of depression,

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whether it's there's an open fracture,

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which they would know clinically if there was a skin defect.

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And then whether there's an ipsilateral tibial shaft

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or fibular fracture.