SCHATZKER IV FRACTURE PATTERN: THE POOR RELATION

Background The Schatzker classification is applied in the management of tibial plateau fractures. The unique pattern of Schatzker VI fractures requires recognition for proper fixation. Method: We have treated 33 patients with Schatzker IV tibial plateau fractures including non-unions and mal-unions. Patients had a temporary spanning Ilizarov frame with intraoperative distraction, articular reconstruction and olive wires for indirect reduction. No open surgery was performed. Patients mobilised fully weight-bearing and underwent post-operative CT scan and regular outpatient reviews. At six weeks the femoral ring was removed, and patients underwent a staged dynamisation protocol prior to frame removal. Results: Twenty seven patients have achieved union and completed at least 1-year follow-up. Of these, 25 were reviewed at a mean follow-up of 5.4 years. The mean IOWA score was 85 and the mean ROM was 119 degrees. Two patients were not contactable for final review. The remaining six patients are still undergoing treatment. The mean time to union was 145 days. Conclusion: Shatzker IV fracture requires understanding of the axial/valgus pattern of injury so that appropriate fixation can be applied to produce good results.