Tibial Plateau Column Division
Three-Column Classification System
The tibial plateau is divided into three columns: lateral, medial, and posterior columns, based on CT imaging—this classification system demonstrates superior interobserver reliability (κ = 0.766) compared to traditional Schatzker classification and is clinically relevant for surgical planning. 1
Column Definitions
The three-column system divides the proximal tibia as follows:
- Lateral column: The lateral tibial condyle, which is the most frequently affected region (81.3% of cases) 2
- Medial column: The medial tibial condyle, involved in 31.1% of fractures 2
- Posterior column: The posterior aspect of the tibial plateau, critical for multiplanar fractures that conventional classifications often fail to adequately describe 3, 1
Four-Column Alternative Classification
A more comprehensive system exists that divides the tibial plateau into four columns and nine segments:
- Four columns: Lateral, intermedial (posteromedian), medial, and fibular columns 2
- Nine segments: These columns are further subdivided, with the most frequently affected segments being the posterolateral (66.1%), anterolateral (64.3%), and posteromedian (53.8%) segments 2
- The fibular column (proximal fibula) is included as the fourth column, involved in 31.0% of cases 2
Clinical Relevance
The three-column classification is specifically useful for complex tibial plateau fractures (Schatzker Types V and VI) where posterior column involvement requires specialized surgical approaches. 3, 1
- The intermedial column (posteromedian region) is affected in 74.4% of cases, making it the second most commonly involved area after the lateral column 2
- Traditional Schatzker classification failed to classify 14 cases in one series, while the three-column system successfully classified all cases 1
- The three-column concept guides surgical approach selection, particularly the combined posterior and anterior-lateral approaches for multiplanar fractures 3
Fracture Distribution Patterns
The frequency of column involvement follows this hierarchy:
- One-column injuries: 30.5% of cases 2
- Two-column injuries: 31.5% of cases 2
- Three-column injuries: 28.0% of cases 2
- All-four-column injuries: 9.9% of cases (when using the four-column system) 2
Key Clinical Pitfall
The posterior column is frequently underappreciated on plain radiographs but is critical for surgical planning—CT-based classification is essential for identifying posterior column involvement that requires specific fixation techniques and surgical positioning. 3, 1