by Rik J. Molenaars, Jos J. Mellema, Job N. Doornberg, and Peter Kloen Tibial Plateau Fracture Characteristics: Computed Tomography Mapping of Lateral, Medial, and Bicondylar Fractures by Rik J. Molenaars, Jos J. Mellema, Job N. Doornberg, and Peter Kloen J Bone Joint Surg Am Volume 97(18):1512-1520 September 16, 2015 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Fracture mapping of tibial plateau fractures is performed by (1) selecting the most proximal subarticular axial CT image as a reference; (2) dynamically scrolling through the axial, sagittal, and coronal CT images to define the origin and subsequent (virtua... Fracture mapping of tibial plateau fractures is performed by (1) selecting the most proximal subarticular axial CT image as a reference; (2) dynamically scrolling through the axial, sagittal, and coronal CT images to define the origin and subsequent (virtual) reduction of respective fragments; and (3) drawing fracture lines and marking zones of comminution on the tibial plateau template. The fracture lines are red, and the zones of comminution are yellow. M = medial, and L = lateral. Rik J. Molenaars et al. J Bone Joint Surg Am 2015;97:1512-1520 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Application of the fracture-mapping technique to a Schatzker type-IV fracture (Fig. 2-A), a Schatzker type-V fracture (Fig. 2-B), and a Schatzker type-VI fracture (Fig. 2-C). Application of the fracture-mapping technique to a Schatzker type-IV fracture (Fig. 2-A), a Schatzker type-V fracture (Fig. 2-B), and a Schatzker type-VI fracture (Fig. 2-C). The individual maps were then superimposed to create a fracture map. A = anterior, L = lateral, and P = posterior. Rik J. Molenaars et al. J Bone Joint Surg Am 2015;97:1512-1520 ©2015 by The Journal of Bone and Joint Surgery, Inc.

A complete fracture map of the 127 tibial plateau fractures in the series. Rik J. Molenaars et al. J Bone Joint Surg Am 2015;97:1512-1520 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Fracture maps of the sixty-four lateral fractures (Fig Fracture maps of the sixty-four lateral fractures (Fig. 4-A), fifteen medial fractures (Fig. 4-B), and forty-eight bicondylar fractures (Fig. 4-C). Fracture maps of the sixty-four lateral fractures (Fig. 4-A), fifteen medial fractures (Fig. 4-B), and forty-eight bicondylar fractures (Fig. 4-C). The orientation is similar to that in Figure 3. Rik J. Molenaars et al. J Bone Joint Surg Am 2015;97:1512-1520 ©2015 by The Journal of Bone and Joint Surgery, Inc.

The main features of tibial plateau fractures are a lateral split fragment with or without depression (Fig. 5-A), a posteromedial fragment (Fig. 5-B), a tibial tubercle fragment (Fig. 5-C), and zones of comminution including the tibial spine (Fig. 5-D). The main features of tibial plateau fractures are a lateral split fragment with or without depression (Fig. 5-A), a posteromedial fragment (Fig. 5-B), a tibial tubercle fragment (Fig. 5-C), and zones of comminution including the tibial spine (Fig. 5-D). The orientation is similar to that in Figure 3. Rik J. Molenaars et al. J Bone Joint Surg Am 2015;97:1512-1520 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Positive (red) and negative (blue) associations between the main fracture features and Schatzker types, and among the main fracture features, with the dark colors indicating significant correlations. Positive (red) and negative (blue) associations between the main fracture features and Schatzker types, and among the main fracture features, with the dark colors indicating significant correlations. LF = lateral split fragment, PMF = posteromedial fragment, and TF = tibial tubercle fragment. Rik J. Molenaars et al. J Bone Joint Surg Am 2015;97:1512-1520 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Schematic representation of the four main features of tibial plateau fractures in a right tibial plateau (cranial view). Schematic representation of the four main features of tibial plateau fractures in a right tibial plateau (cranial view). Blue = lateral split fragment, green = posteromedial fragment, red = tibial tubercle fragment, and yellow = zone of comminution including the tibial spine. Rik J. Molenaars et al. J Bone Joint Surg Am 2015;97:1512-1520 ©2015 by The Journal of Bone and Joint Surgery, Inc.

Two examples of the continuous spectrum of posteromedial fracture lines ranging from parallel (star in Fig. 8-A) to anteroposterior (star in Fig. 8-B) with respect to the posterior femoral condylar axis. Two examples of the continuous spectrum of posteromedial fracture lines ranging from parallel (star in Fig. 8-A) to anteroposterior (star in Fig. 8-B) with respect to the posterior femoral condylar axis. Fig. 8-A Anteroposterior radiograph made after open reduction and internal fixation of a Schatzker type-V fracture in the left knee of a forty-five-year-old woman as well as a postoperative CT scan illustrating an unfixed large posterior bicondylar fragment (star). This particular fracture component might have warranted an additional posteromedial or posterior approach. Fig. 8-B Preoperative CT scans and postoperative radiographs of a Schatzker type-IV fracture in the right knee of a forty-seven-year-old woman treated through a single medial approach. The impacted posterocentrolateral fragments were reduced through the medial plateau fracture opening. Rik J. Molenaars et al. J Bone Joint Surg Am 2015;97:1512-1520 ©2015 by The Journal of Bone and Joint Surgery, Inc.