Functional Outcomes and Surgical Utility of the Modified Schatzker Four-column Concept in Proximal Tibial Plateau Fractures: A Prospective Observational Study.

INTRODUCTION

Proximal tibial plateau fractures are complex intra-articular injuries with significant implications for knee function. Conventional classification systems, such as the Schatzker classification, are limited in their ability to identify posterior column involvement. The modified Schatzker four-column concept, based on computed tomography (CT), provides a more comprehensive understanding of fracture morphology and may improve surgical planning and outcomes. This study aims to evaluate the utility of the four-column concept in guiding management and its association with functional outcomes.

MATERIALS AND

METHODS

This prospective observational study was conducted at a tertiary care center between January 2024 and April 2025. Thirty skeletally mature patients with closed proximal tibial plateau fractures were included. All fractures were classified using CT-based modified Schatzker (four-column) classification. Surgical management was tailored based on column involvement using appropriate approaches and fixation strategies, including single or dual plating. Functional outcomes were assessed using the Knee Society Score (KSS) and Modified Rasmussen Functional Score. Radiological union and complications were also evaluated over a minimum follow-up of 6 months.

RESULTS

The most common fracture pattern was anterolateral (AL) with posterolateral (PL) involvement (AL + PL) which was observed in 10 patients (33.3%), followed by other two-column injuries, while four-column fractures accounted for 20%. All fractures achieved union at a mean of 14.2 weeks. Functional outcomes were predominantly good to excellent, with mean KSS ranging from 75 to 90 and Rasmussen scores from 20 to 28. Four-column fractures demonstrated higher mean Rasmussen scores (27.0) compared to two-column fractures (24.2). Functional outcomes showed a significant association with fracture morphology (KSS P = 0.021; Rasmussen P = 0.008). Dual plating yielded significantly better outcomes than single plating (P < 0.05). Complications were minimal, with 86.7% of patients having an uneventful recovery.

CONCLUSION

The four-column concept is a valuable tool in the management of proximal tibial plateau fractures. It facilitates accurate fracture characterization, guides surgical approach, and is associated with favorable functional outcomes, particularly when combined with column-specific fixation strategies such as dual plating.