A Prospective Study - CT-based Three-column Theory versus X-ray-based Schatzker Classification - treated with Open Reduction with Locking Compression Plates

Q: What was the study’s primary aim?

To compare functional outcomes of complex tibial plateau fractures classified using CT-based three-column theory versus X-ray-based Schatzker classification and treated with locking compression plates.

Q: How were patients allocated into the two study groups?

Forty-four patients with closed Schatzker type V and VI fractures were enrolled and split into Group A (CT-based three-column classification, n=22) and Group B (X-ray-based Schatzker classification, n=22).

Q: Which classification method produced better outcomes and what were the key perioperative differences?

CT-based three-column classification (Group A) showed significantly better Rasmussen scores at multiple follow-up points and had shorter operative time, reduced blood loss, lower radiation exposure, and fewer complications than the Schatzker group.

Sep 29, 2026

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A prospective observational study compares functional outcomes in 44 patients with closed Schatzker type V and VI complex tibial plateau fractures. Patients were classified by CT-based three-column theory (Group A, n=22) versus X-ray-based Schatzker classification (Group B, n=22) and treated with anatomical locking compression plates. Outcomes were evaluated using the Rasmussen clinical score across follow-ups, alongside operative variables, radiation exposure, blood loss, and postoperative complications. CT-based classification improved surgical precision and functional results while reducing perioperative morbidity.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Introduction

Materials and Methods

Results

Conclusion

Keywords

Original Article Journal of Orthopaedic Case Reports 2025 December:15( 12) :Page 315-320 A Prospective Study Comparing the Functional Outcomes of Complex Tibial Plateau Fractures Using Computed Tomography-based Three-column Theory Versus X-Ray-based Schatzker Classification Treated with Open Reduction with Locking Compression Plates Rajiv Munde¹, Santosh Borkar¹, Abhinav Prabhu ¹, Ashwinikumar Madavi ¹, Suraj Sudarshan Doshi¹, Rahul Vithal Ravariya¹ Learning Point of the Article: CT imaging demonstrates superior accuracy in fracture characterization and pre-operative planning compared to conventional radiography, thereby contributing to improved surgical precision and functional outcomes in tibial fractures. Abstract Introduction: Tibial plateau fractures are complex intra-articular injuries that require precise classification for optimal management. The widely used Schatzker classification, based on X-rays, provides a two-dimensional assessment, while the computed tomography (CT)-based three-column theory offers amore detailed three-dimensional analysis. This study aimed to compare the functional outcomes of complextibial plateaufractures classified using these two systems and treated with locking compressionplates (LCP). Materials and Methods: A prospective, observational study was conducted involving 44 patients with closed Schatzker type V and VI tibial plateau fractures. Patients were allocated into two groups: Group A (n = 22) based on CT-based three-column classification and Group B (n = 22) based on X-ray-based Schatzker classification. All patients underwent open reduction and internal fixation using anatomical LCPs. Functional outcomes were assessed using the Rasmussen clinical score at regular follow-ups. Intraoperative variables and post-operative complications were also analyzed. Results: Group A showed significantlybetter Rasmussen scores at 6, 12, 24, and 36weeks (P < 0.05), alongwith shorter operative time, reduced blood loss, lower radiation exposure, and fewer complications compared to Group B. Joint stiffness and post-traumatic arthritis were notably higherin the Schatzker group. Conclusion: CT-based three-column classification enables more accurate surgical planning and leads to superior functional and perioperative outcomesin complextibialplateaufractures compared to the Schatzker classification. Keywords: Classification, computed tomography, lockingplate, Schatzker, tibialplateaufracture. Introduction surface of the tibia, serves as a critical load-bearing region of the The tibial plateau, which constitutes the superior articular knee joint [1]. Patients with osteopenic bone have a higher |
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Website: [www.jocr.co.in](www.jocr.co.in)

DOI:
[https://doi.org/10.13107/jocr.2025.v15.i12.6546](https://doi.org/10.13107/jocr.2025.v15.i12.6546) | Author’s Photo Gallery | | | | | | | --- | --- | --- | --- | --- | --- | --- | | | | | | | | | | | | Dr. Santosh Borkar Dr. Abhinav Prabhu Dr. Ashwinikumar Madavi Dr. Suraj Sudarshan Doshi Dr. Rahul Vithal Ravariya | | | | | | |
1Department of Orthopaedics, Maharashtra Institute of Medical Education and Research Medical College, Pune, Maharashtra, India.
Address of Correspondence:
Dr. Rahul Vithal Ravariya,
Department of Orthopaedics, Maharashtra Institute of Medical Education and Research Medical College, Pune, Maharashtra, India.
E-mail: [rahulravariya5@gmail.com](rahulravariya5@gmail.com) | | | | | | | Submitted: 10/09/2025; Review: 22/10/2025; Accepted: November 2025; Published: December 2025 | | | | | | | | DOI: [https://doi.org/10.13107/jocr.2025.v15.i12.6546](https://doi.org/10.13107/jocr.2025.v15.i12.6546)
© The Author(s). 2025 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ([https://creativecommons.org/licenses/by-nc/4.0/](https://creativecommons.org/licenses/by-nc/4.0/)),

FAQs

What was the study’s primary aim?

To compare functional outcomes of complex tibial plateau fractures classified using CT-based three-column theory versus X-ray-based Schatzker classification and treated with locking compression plates.

How were patients allocated into the two study groups?

Forty-four patients with closed Schatzker type V and VI fractures were enrolled and split into Group A (CT-based three-column classification, n=22) and Group B (X-ray-based Schatzker classification, n=22).

Which classification method produced better outcomes and what were the key perioperative differences?

CT-based three-column classification (Group A) showed significantly better Rasmussen scores at multiple follow-up points and had shorter operative time, reduced blood loss, lower radiation exposure, and fewer complications than the Schatzker group.

Sep 29, 2026

Upload by hdkawk