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Diagnosis and Surgical Treatment of Schatzker Type IV Variant Biplanar Medial Tibial Plateau Fractures in Alpine Skiers

Fractures of the tibial plateau frequently are associated with significant intraarticular injuries that generally require surgical treatment. The commonly used Schatzker classification of tibial plateau fractures first described in 1979 includes 6 types of fractures, I to VI. In the original description of this system, Type IV fractures involved the medial tibial plateau and were described as either (1) split-wedge types or (2) depressed and comminuted, and the prognosis for these fractures was reported to be poor. Frequently attributed to a high-energy injury, these fractures are commonly felt to be caused by a varus force. In our experience, some Type IV fractures found in injured alpine skiers neither fit this pattern of injury, are not adequately described by this system, nor is the surgical treatment well defined. These fractures can pose surgical treatment difficulties, especially if the complex, biplanar, or rotational nature of this variant is not recognized and adequately reduced and stabilized. This Schatzker Type IV variant found in alpine skiers is described with emphasis on recognition, diagnosis, and optimal surgical treatment of this serious complex intraarticular fracture.