After x rays confirm that you have a fractured tibial plateau, the next step for the surgeon will be answering the questions, “How severe is the fracture?” and “What type of fracture is it?” Surgeons use a classification system to grade the degree of injury, formulate a surgical plan and arrive at a likely prognosis (outcome). The most widely used system in Australia and the USA is the Schatzker classification system. It is composed of six condyle fracture types classified by the bone fracture pattern and the displacement of the bone fragments. Here we go… more bloody jargon!
A condyle is the round prominence at the end of a bone. In the tibia there are two at the top behind your kneecap – the medial and lateral condyles, both of which can be fractured. The lateral is on the outside of the right knee and the medial is on the inside of the right knee. There you go that wasn’t too hard was it? And it wasn’t even Latin. Condyle is from an old Greek word meaning “knuckle”. Bloody doctors! I fractured my lateral condyle.
Under the Schatzker system, each increasing number denotes increasing force trauma and severity. The severity correlates with the amount of energy imparted to the bone at the time of injury. The most common type of Schatzker classification in skiing are type 1 and type 11 injures. These are relatively minor. I suffered a type 11 fracture, very typical of a skiing accident.
Schatzker classification for tibial plateau fracture:
Type I = Lateral Tibial plateau fracture without depression.
This is a wedge-shaped cleavage break and involves a vertical split of the lateral tibial plateau. It is a low energy injury. It’s caused by a valgus force combined with axial loading (ie a downwards force along the line of your body). It’s the top half of your body smashing into the bottom half, that leads to the lateral condyle in the femur (bone in your upper leg) being driven into the articular surface of the tibial plateau at the top of your lower leg. Ouch! This represents about 6% of all tibial plateau fractures.
Type II = Lateral tibial plateau fracture with depression,
Yea! This is me! This is a combined cleavage and compression break and involves a vertical split of the lateral condyle combined with depression of the adjacent load bearing part of the condyle. This is also caused by a valgus force on the knee; it is classed as a low energy injury, but doesn’t feel like it when you hit the snow and your leg breaks. This is the most common form of tibial plateau fracture and makes up 75% of all tibial plateau fractures. There is a risk of injuries to the medial collateral ligament (MCL) in this type of break as the joint opens up and stretches the ligament as you impact the snow. You may also suffer damage to the anterior cruciate ligament (ACL).I strained, but did not tear my MCL. Hurt like hell for about 2 months after the injury. However, this is one of the the things that really went right for me. Trying to do rehab with a broken leg and a torn ACL or MCL would be just a huge pain in the arse!
I wont go on. You don’t want to know about types III, IV, V and VI. Very unpleasant especially type VI! You are unlikely to experience the joys of these fractures in skiing so lets stay on topic.
The following will not help your recovery in any way!