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Background
Accurate description of tibial plateau fractures is vital for interdisciplinary communication and treatment. This exhibit reviews tibial plateau fracture classification and its implications on surgical planning.

Educational Goals / Teaching Points
This presentation illustrates the benefits and limitations of the Schatzker and AO/OTA systems, highlights the added value of the three-column system and impact of associated soft tissue and proximal tibiofibular joint injury on surgical planning, and offers structured approach to reporting.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit reviews and compares the Schatzker, AO/OTA and three-column system classification systems of tibial plateau fractures. The Schatzker classification system is widely used among radiologists offers a valuable framework for characterizing fractures based on condylar involvement and displacement, describes common fracture lines, and facilitates triage due to its grading by injury severity. The limitations of the Schatzker system include failure to address the posterior column and failure to predict the structural stability of the tibial plateau. In contrast, the three-column system provides a concise assessment of fracture stability by dividing the plateau into anatomical columns, which helps predict displacement potential. However, it can oversimplify complex fracture patterns and fails to fully address articular involvement. This exhibit will examine treatment approaches for tibial plateau fractures. Standard operative approaches are indicated for fractures meeting thresholds of articular depression, condylar widening, degrees of varus or valgus instability, and specific fracture morphologies, and associated injuries. External fixation may be considered for severe or comminuted fractures, and arthroplasty may be an option for osteopenic patients. Nonoperative measures are generally reserved for minimally displaced fractures, nonambulatory patients, or poor surgical candidates. Additional anatomic and physiologic considerations revolve around soft tissue injuries. Developing a diagnostic checklist for interpreting tibial plateau fractures will reinforce fundamental concepts and provide radiologists with an actionable approach to communicate findings effectively.

Conclusion
Radiologists are crucial in conveying imaging findings to surgical teams. After reviewing this presentation, the participant will develop a more nuanced understanding of the tibial plateau fracture classification and associated injuries and adopt a comprehensive diagnostic checklist.