Reátiga 

Aguilar et al.
Journal of Orthopaedic Surgery and Research (2022) 17:106
https://doi.org/10.1186/s13018-022-02988-8

RESEARCH ARTICLE Open Access

Epidemiological characterization of tibial

plateau fractures
Juan Reátiga Aguilar1*  , Ximena Rios1, Eduardo González Edery2  , Alfredo De La Rosa3 and
Laura Arzuza Ortega4 

Abstract 
Background:  Tibial plateau fractures are traumatic injuries with severities ranging from nondisplaced to complicated
fractures. This study describes the epidemiological characteristics of patients with tibial plateau fractures treated in
five trauma clinics.
Methods:  This retrospective, cross-sectional study included 1165 patients with tibial plateau fractures treated
between December 2015 and May 2017. Subjects were selected from the medical records of five institutions based
on the inclusion and exclusion criteria. Age, sex, laterality, fracture type, trauma mechanism, vehicle type, classifica-
tion, and associated injuries were assessed via univariate and bivariate analyses.
Results:  In total, 23.3% of patients with tibial fractures treated during the study period had tibial plateau fractures. Of
those affected, 73% were men and 50% were younger than 40 years. Furthermore, 95.7% of fractures were caused by
traffic accidents, 82.6% of which involved motorcycles. Fractures were closed in 93.1% of cases, and 78% of subjects
had associated injuries. The most common fractures, according to Schatzker classification, were type VI (23%) and V
(19.1%) fractures.
Conclusions:  Tibial plateau fractures are frequent injuries in our setting and mostly occur in men in their 30 s and
40 s. These fractures are typically caused by motorcycle traffic accidents.
Level of Evidence.IV.
Keywords:  tibial fracture, Tibial plateaus, Trauma mechanisms

Background The term “pilon” was first used in 1911 by the radiolo-
Tibial plateau fractures are an important group of trau- gist Étienne Destot to describe “explosive injuries with
matic pathologies; their high frequency in recent years the talus impacting the tibia like a hammer hits a nail”
and the severity of complications present challenges for [4]. In 1950, Bonin used the term “plafond” (ceiling) to
orthopedists [1, 2]. Their reported incidence is approxi- describe joint fractures resulting from the impact of the
mately 1% of all fractures and 8% of fractures among talus on the tibia due to an axial load [5].
elderly people [3]. Tibial plateau fractures manifest with various morpho-
logical patterns [6], ranging from nondisplaced closed
fractures to complicated fractures with significant soft
tissue and neurovascular damage that can compromise
*Correspondence: [email protected] lower limb viability and require complex and extensive
1
Orthopedics and Traumatology Department, Grupo Campbell, treatment [7].
Barranquilla, Colombia
Full list of author information is available at the end of the article

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the
original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or
other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line
to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory
regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this
licence, visit http://​creat​iveco​mmons.​org/​licen​ses/​by/4.​0/. The Creative Commons Public Domain Dedication waiver (http://​creat​iveco​
mmons.​org/​publi​cdoma​in/​zero/1.​0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Reátiga Aguilar et al. Journal of Orthopaedic Surgery and Research (2022) 17:106 Page 2 of 7

Variations in the clinical presentation of fractures and those without knee tomography in their diagnostic
depend on the force of the impact, age of the patient, and examinations were excluded from this study.
degree of knee flexion at the time of injury [7]. These are This study was approved by the institutional ethics
important parameters for the initial clinical assessment committee in accordance with the current regulations
of fracture classification and the selection of appropriate under Resolution 8430 of 1993 of the Ministry of Health
therapeutic approach [8]. of Colombia considering that this work presented no risk
Functional results can range from full recovery to gait to the participants. This study complied with the princi-
disturbances and complications, which increase the func- ples of the Declaration of Helsinki and the International
tional disabilities and incapacities of patients and affect Council for Harmonisation of Technical Requirements
their well-being and productive capacity, thereby increas- for Pharmaceuticals for Human Use, thereby respecting
ing health-related costs [8]. the dignity and protecting the rights and well-being of
Complications occur in 13–88% of cases of tibial pla- the people. As a no-risk study, informed consent was not
teau fractures [1, 9]. The most common complications required.
include the following: superficial and deep infections in The collected data were processed using IBM SPSS
6.4–16.1% of cases [3, 8, 10], ligament injuries in 20–30% Statistics for Windows, version 25.0. For this purpose,
of cases, meniscal injuries in 10–47% of cases, posterior an Excel database was constructed, describing the abso-
tibial nerve and common peroneal nerve involvement in lute and relative frequencies of the study variables as
2–4% of cases [8], and deep vein thrombosis in 1.8–5.6% well as the measures of central tendency and dispersion.
of cases [1, 10]. Pseudarthrosis of the metaphyseal–dia- Depending on the variable, normality tests were per-
physeal junction, joint stiffness with loss of lower limb formed using Kolmogorov–Smirnov test. Chi-squared
mobility, and posttraumatic osteoarthritis are among the and Wilcoxon–Mann–Whitney tests were used for com-
late-onset complications of these fractures [4]. The inci- parisons. Statistical significance was indicated by p < 0.05,
dence of posttraumatic osteoarthritis has been reported and the parameters were estimated with a 95.0% confi-
to be particularly high, and Jagdev et al. [11], Manidakis dence level.
et  al. [10], and Vega et  al. [8] identified osteoarthritis in The variables considered for the analysis included both
73.34%, 26.4%, and 24% of cases, respectively. sociodemographic factors (age and sex, characteristics of
The increased frequency of tibial plateau fractures and the affected individual, and type of vehicle involved) and
their multiple complications highlight the high impact of clinical factors (trauma mechanism, fracture type, injury
this pathology on public health. Therefore, the specific laterality, associated injuries, and fracture classification).
characteristics of these patients must be determined. Tibial plateau fractures were classified according to
Accordingly, this study aimed to describe the epidemio- Schatzker classification [12] following radiological and
logical characteristics of patients diagnosed with tibial morphological evaluation. This classification includes six
plateau fractures. types of fractures, with each numerical increase repre-
senting an increase in injury severity; after determining
Methods the injury severity, treatment plans were established [2]
This descriptive, retrospective, cross-sectional study (Table 1).
included 1165 patients with tibial plateau fractures
treated between December 1, 2015, and May 31, 2017, at Results
five Colombian clinics. In total, 23.3% (1.165) of patients with tibial fractures
The participants were selected by searching the medi- treated in the five trauma clinics during the study period
cal records in the information systems of the respective had tibial plateau fractures.
institutions for the codes CUPS 773705, SOAT 13580, Table  1 shows that a higher proportion of these frac-
and tibial osteosynthesis, which led to the identifica- tures occurred in men (73%) than in women (27%); more-
tion of 4426 patients with tibial fractures treated during over, 50% of the affected individuals were younger than
this period. The clinical histories of these patients were 40  years of age (interquartile range = 20). Furthermore,
reviewed, and 1165 cases were selected based on the 95.7% of the fractures were caused by traffic accidents,
inclusion and exclusion criteria. 82.6% of which were associated with motorcycles. Closed
The inclusion criteria were a diagnosis of tibial plateau fractures were the most common fracture type, account-
fracture confirmed by X-ray, tomography, or an ortho- ing for 93.1% of the fractures, with 53% of the fractures
pedic doctor with complete records of the variables occurring in the left leg and 78% of the subjects pre-
assessed in this study. Cases with immature skeletons, senting with fracture-associated ligament and meniscal
metabolic bone disease, and isolated tibial spine fractures injuries.
 Reátiga Aguilar et al. Journal of Orthopaedic Surgery and Research (2022) 17:106 Page 3 of 7

Table 1  Schatzker classification system of tibial plateau fractures

Fracture type Condylar fracture pattern Description

Type I Lateral condyle fracture The lateral femoral condyle is driven into the articular surface of the tibial plateau. Shearing fracture
pattern that is split off and displaced outwards and Downward
Type II Lateral condyle fracture Lateral wedge split with an articular surface depression of the lateral condyle
Type III Lateral condyle fracture Lateral condyle depressed fracture without split
Type IV Medial condyle fracture Any fracture patterns that affect only the medial condyle
Type V Bicondylar fracture Both tibial plateaus are fractured. The fracture line often has the appearance of an inverted Y. There may
be an associated fracture of the intercondylar eminence
Type VI Dissociation of the tibial Transverse or oblique fracture of the proximal tibia which results in dissociation of metaphysis from the
metaphysis and diaphysis diaphysis with varying degrees of comminution of one or of both tibial condyles and articular surface
Source: Schatzker et al. “The Tibial Plateau Fracture. The Toronto Experience 1968–1975”

Fig. 1  Percentage of tibial plateau fractures by age and gender. Data taken from investigations group database—December 2015 to May 2017

Figure  1 shows that in women, these fractures were 2013 [14], as well as those observed in this study. Schatz-
most common among those aged 20–29  years and ker reported a higher frequency of low-energy type II
30–39 years (29%). Conversely, in men, they were most (25%) and III (36%) fractures, similar to Zhu et  al., who
common among those aged 30–39  years (26%) and also reported a higher prevalence of low-energy type II
40–49 years (25%). Traffic accidents resulted in a higher (35%) and IV (25%) fractures. Albuquerque et al. reported
number of tibial plateau fractures in men (73.3%) than a higher frequency of type II (35.1%) and VI (20.1%) frac-
in women (26.7%) (p = 0.03). Similarly, men had a tures, whereas high-energy type VI (23%) and V (19%)
higher number of associated meniscal and ligament fractures were the most common in the present study
injuries than women (75.3%) (p = 0.003). No significant (Table 3).
differences in other prevalence rates between sexes Figure  4 shows the percentages of tibial plateau frac-
were observed (Table  2). The most common tibial pla- tures based on the degree of severity reported previously
teau fractures were Schatzker type VI (23%), type V and in the present study, highlighting the higher percent-
(19%), and type II (18.1%) (Fig. 2). ages of bicondylar fractures in this study (42%) than those
Figure  3 presents the percentages of fracture types reported by Schatzker et  al. (23%) [12], Zhu et  al. (26%)
reported by other authors, including Schatzker in 1975 [13], and Albuquerque et al. (36%) [14].
[12], Zhu et  al. in 2012 [13], and Albuquerque et  al. in
Reátiga Aguilar et al. Journal of Orthopaedic Surgery and Research (2022) 17:106 Page 4 of 7

Table 2  Demographic characteristics to the increased use of motorized vehicles, particularly

Variable Category n = 1165 %
motorcycles, and the risky acts of drivers [3, 8, 13, 14]. A
Forensis report revealed that 45,806 people were injured
Gender Male 851 73.0 in traffic accidents in Colombia in 2015, of which 54.9%
Female 314 27.0 involved motorcycles [15]. In 2018, the National Road
Extremity Left Safety Observatory (Observatorio Nacional de Seguridad
Extremity Right 618 53.0 Vial; ONSV) reported that 6476 people died and 37,213
Fracture type Closed fracture 547 47.0 people were injured in road accidents in Colombia and
Fracture type Open fracture 1085 93.1 that the most affected victims were motorcycle users,
Mechanism of injury Work accident 80 6.9 accounting for 48.3% of the total deaths and 56% of the
Mechanism of injury Fall from a height 3 0.3 total number of injured people [14].
*Vehicle type Road crash accident 31 2.7 In our study, these fractures primarily affected younger
Sport-related injury 1115 95.7 people in their 30  s and 40  s, who were economically
Blunt trauma 1 0.1 active and mostly men, corroborating the reports of
Others 1 0.1 Vega et  al. [8] in Bogotá, Colombia, in 2013 and Albu-
Motor bicycle 14 1.2 querque et  al. [14] in Brazil in 2013. These findings
Bicycle 921 82.6 could be explained by the higher exposure of young men
Car 33 3.0 to traffic accidents according to ONSV, with a ratio of
Associated injuries Present 161 14.4 approximately 1.6 men for every woman injured in traf-
Of soft tissues Absent 914 78.5 fic accidents [16]. These accidents decrease patients’
251 21.5 productive capacity and increase costs resulting from
Data taken from investigations group database—December 2015 to May 2017 disabilities and rehabilitation treatment.
Another key finding of this study was the higher per-
centage of high-energy Schatzker type VI and V tibial
Discussion plateau fractures, with a ratio between the percentages
The percentage of tibial plateau fractures observed in of high- and low-energy fractures being 58/42, which
this study is higher than that reported in the literature was in contrast to the ratios of 77/23, 73/26, and 64/36
[2, 3]. This shows that this type of injury is common in in the studies by Schatzker et al. [12], Zhu et al. [13], and
our setting, most likely as a result of the increase in traf- Albuquerque et  al. [14], respectively. The results high-
fic accidents in Colombia in recent years, which is related light the considerable increase in high-energy fractures

Fig. 2  Percent distribution of tibial plateau fractures by Schatzker classification. Data taken from investigations group database—December 2015
to May 2017
 Reátiga Aguilar et al. Journal of Orthopaedic Surgery and Research (2022) 17:106 Page 5 of 7

Fig. 3  Percentage proportion comparison of Schatzker classification fracture type in the published literature. Data taken from investigations group
database—December 2015 to May 2017

Table 3  Prevalence of tibial plateau fractures

Female Male p value

Total 314(27%) 851(73%)

Age (median, RI) 39 RI = 20 35 RI = 20 40 RI = 22 0.01
Extremity Left 165 (26.7%) 453 (73.3%) 0.84
Right 149 (27.2%) 398 (72.8%)
Fracture type Closed 298 (27.5%) 787 (72.5%) 0.14
Open 16 (20%) 64 (80%)
Mechanism of injury Road crash 298 (26.7%) 817 (73.3%) 0.03
Work 0 3 (100%)
Accident fall from a height 14 (45.2%) 17 (54.8%)
Sport injury 1 (100%) 0
Others 1 (7.1%) 13 (92.85%)
Blunt trauma 0 1 (100%)
*Vehicle type Bicycle 7 (24.1%) 22 (75.9%) 0.12
Motor 235 (25.5%) 686 (74.5%)
Bicycle car 56 (33.9%) 109 (66.1%)
Soft tissue Injuries (Meniscal o Ligamentous Present 226 (24.7%) 688 (75.3) 0.001
Tears) Absent 88 (35.1%) 163 (64.9%)
Classification (Schatzker et al.) Type I 37 (25%) 111 (75%) 0.6
Type II 62 (29.4%) 149 (70.6%)
Type III 54 (30%) 126 (70%)
Type IV 40 (27.6%) 105 (72.4%)
Type V 51 (23%) 171 (77%)
Type VI 70 (27%) 189 (73%)
Data taken from investigations group database—December 2015 to May 2017
Reátiga Aguilar et al. Journal of Orthopaedic Surgery and Research (2022) 17:106 Page 6 of 7

Fig. 4  Percentage proportion comparison of tibial plateau fractures classified by condylar involvement reported in the literature. Data taken from
investigations group database—December 2015 to May 2017

in our setting. These fractures are characterized by com- Funding

The present study did not receive any funding.
promised tibial plateaus and increased soft tissue injury
around the knee [14], which are closely related to the
high-energy trauma mechanism. Declarations
In our study, the percentage of bicondylar injuries was Competing interests
higher (42%) than that reported by Schatzker et al. (23%) The authors declare that they have no competing interests.
[12], Zhu et al. (26%) [13], and Albuquerque et al. (36%) Author details
[14], demonstrating the variations in this type of fracture. 1
 Orthopedics and Traumatology Department, Grupo Campbell, Barranquilla,
The increase in more complex injuries has a high impact Colombia. 2 Orthopedics and Traumatology Department, Clínica Valle Salud
Sur Cali, Valle del Cauca, Colombia. 3 Orthopedics and Traumatology Depart-
on public health owing to their serious complications, ment, Clinica Bahia, Santa Marta, Colombia. 4 Magister Epidemiology, Grupo
which require management in specialized trauma care Campbell, Barranquilla, Colombia.
centers for a timely and accurate diagnosis to establish
Received: 1 January 2022 Accepted: 3 February 2022
adequate treatment and rehabilitation strategies [3].

Conclusions
Tibial plateau fractures are common injuries in our References
1. Cuéllar-Avaroma A, King-Martínez AC, Hernández-Salgado A, Torres-
setting, primarily occurring in men in their 30  s and González R. Complicaciones en las fracturas complejas de la meseta tibial
40  s, and are most often caused by motorcycle traffic y factores asociados. Cir Ciruj. 2006;74(5):351–7.
accidents. 2. Álvarez LA, García L, Gutiérrez BM, Montanchez SD. Clasificación de
Schatzker en las fracturas de la meseta tibial. AMC. 2010;14(6):1–11.
The frequency of high-energy Schatzker V and VI frac- 3. Carredano X, Valderrama J, Marín F, Valderrama I, Espinoza G. Complica-
tures was higher in this study than in other published ciones en fracturas de platillos tibiales de alta energía. Rev Chil Ortop
studies. Traumatol. 2016;57:3.
4. Cutillas IM. Valoración de resultados de las fracturas del pilon tibial. Tesis
Because of the complexity of these injuries, their man- de grado. Elche: Universidad Miguel Hernández; 2009.
agement in specialized trauma centers should be con- 5. Ortíz P, Allende B, Allende B. Fracturas del pilón tibial ¿Cómo repercuten
sidered under comprehensive fracture management en la calidad de vida? Rev Asoc Argent Orton Traumatol. 1970;70:339–51.
6. Allende DP, Scheu G, Carredano G, Colmenares S, Yáñez L, Donoso M,
strategies, guaranteeing a long-term follow-up of patients et al. Principios quirúrgicos en fracturas de platillos tibiales con compro-
undergoing surgical treatment for tibial plateau fractures. miso de columna posterior. Rev Chil Ortop Traumatol. 2018;59(1):22–34.
7. Robledo-Herrera O, Diego-Ball D, Oliva-Ramírez S. Abordaje posterome-
dial y colocación de placa en fractura de meseta tibial con fragmento
Abbreviation posterior. Acta Ortop Mex. 2015;29:2.
ONSV: Observatorio Nacional de Seguridad Vial. 8. Vega-Caicedo R, Piñeros-Ramírez DF, Galván-Villamarín F, Medina-Casti-
blanco C. Descripción epidemiológica y evaluación de los desenlaces de
Acknowledgements interés de las fracturas de platillos tibiales. Rev Facult Med. 2013;61:25–33.
We thank Edanz (www.​edanz.​com/​ac) for editing a draft of this manuscript.
 Reátiga Aguilar et al. Journal of Orthopaedic Surgery and Research (2022) 17:106 Page 7 of 7

9. Borade A, Kempegowda H, Richard R, Graham J, Suk M, Horwitz DS. Is

“early total care” a safe and effective alternative to “staged protocol” for
the treatment of Schatzker IV-VI tibial plateau fractures in patients older
than 50 years? J Orthop Trauma. 2017;31:e400–6.
10. Manidakis N, Dosani A, Dimitriou R, Stengel D, Matthews S, Giannoudis P.
Fracturas de la meseta tibial: resultado funcional e incidencia de osteoar-
tritis en 125 casos. Ortop Int. 2010;34(4):565–70.
11. Jagdev S, Pathak S, Kanani H, Salunke A. Functional outcome and inci-
dence of osteoarthritis in operated tibial plateau fractures. Arch Bone Jt
Surg. 2018;6:508.
12. Schatzker J, Mcbroom R, Bruce D. The tibial plateau fracture. The Toronto
experience 1968–1975. Clin Orthop Relat Res. 1979;138:94–104.
13. Zhu Y, Yang G, Luo C, Smith W, Hu C, Gao H, et al. Computed tomography-
based three-column classification. J Trauma Acute Care Surg. 2012;73:3.
14. Albuquerque R, Hara R, Prado J, Schiavo L, Giordano V, Amaral N, et al.
Estudo epidemiológico das fraturas do planalto tibial em hospital de
trauma nível I. [electrónicos]. Rio de Janeiro. 2013. Accessed 17 Oct 2017.
15. Instituto Nacional de Medicina Legal y Ciencias Forenses. Grupo Centro
de Referencia Nacional sobre Violencia. Comportamiento de muertes
y lesiones por accidentes de transporte, Colombia 2015. Bogotá: Cudi-
namarca. 2015.
16. Observatorio Nacional de Seguridad Vial. Boletín estadístico Colombia
enero - diciembre 2017–2018. Accessed Dec 2018.

Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in pub-
lished maps and institutional affiliations.

Ready to submit your research ? Choose BMC and benefit from:

• fast, convenient online submission

• thorough peer review by experienced researchers in your field
• rapid publication on acceptance
• support for research data, including large and complex data types
• gold Open Access which fosters wider collaboration and increased citations
• maximum visibility for your research: over 100M website views per year

At BMC, research is always in progress.

Learn more biomedcentral.com/submissions