Predictors of Fracture-Dislocation in Schatzker IV Tibial Plateau Fractures: A Reproducible, Quantitative MRI-Based Injury-Pattern Analysis (fracture)

This retrospective observational case-control study aims to evaluate imaging features and associated soft-tissue injury patterns in patients with Schatzker type IV tibial plateau fractures. Adult patients treated surgically at a single tertiary trauma center between January 2019 and December 2025 are included if complete preoperative radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) are available. Participants are categorized into fracture-dislocation and non-dislocation groups based on preoperative imaging findings. The study evaluates morphological characteristics of the lateral and posterolateral tibial plateau on CT as well as associated soft-tissue injuries on MRI, including ligamentous, meniscal, and bone contusion patterns. The objective of the study is to characterize imaging features associated with fracture-dislocation and to explore relationships between osseous injury morphology and soft-tissue injury patterns in Schatzker type IV tibial plateau fractures.

Study Overview

• Status: Completed
• Conditions: Tibial Plateau Fracture
• Intervention / Treatment: Behavioral: Is it dislocation?

Detailed Description

This single-center retrospective observational case-control study evaluates imaging characteristics and associated soft-tissue injury patterns in patients with Schatzker type IV tibial plateau fractures. The study population consists of adult patients who underwent surgical treatment at a tertiary trauma center between January 2019 and December 2025.

Eligible participants are identified through review of medical records and imaging archives. Inclusion criteria include age between 18 and 70 years and availability of complete preoperative imaging, including radiographs, CT scans, and MRI examinations. Exclusion criteria include fractures other than Schatzker type IV, prior surgery of the affected knee, pathologic fractures, advanced osteoarthritis, and incomplete or poor-quality imaging data.

Participants are categorized into fracture-dislocation and non-dislocation groups according to predefined imaging criteria based on CT and MRI findings. The study assesses quantitative imaging parameters describing tibial plateau morphology, including measurements of posterolateral plateau depression and lateral plateau widening. MRI is used to evaluate associated soft-tissue injuries, including injuries of the lateral meniscus, anterior cruciate ligament, posterior cruciate ligament, lateral collateral ligament, posterolateral corner structures, and bone contusions.

The purpose of this study is to evaluate imaging characteristics associated with fracture-dislocation and to investigate the relationship between tibial plateau fracture morphology and concomitant soft-tissue injuries. No study intervention is assigned, and all data are derived from retrospective review of existing clinical and imaging records obtained during routine clinical care.

• Study Type: Observational
• Enrollment (Actual): 77

Contacts and Locations

Study Locations

• China
  • Jiangsu
    • Schoow, Jiangsu, China, 252000
      • The medical record system and imaging system of the Second Affiliated Hospital of Soochow University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Adult patients with surgically treated Schatzker type IV tibial plateau fractures treated at a single tertiary trauma center between January 2019 and December 2025 were retrospectively reviewed. Eligible patients had complete preoperative radiographs, CT scans, and MRI examinations. Patients were categorized into fracture-dislocation and non-dislocation groups based on preoperative imaging findings. Demographic data, imaging parameters, and associated soft-tissue injuries were analyzed.

Description

Inclusion Criteria:

• Adults aged 18 to 70 years

Surgically treated Schatzker type IV tibial plateau fracture

Wahlquist type B or C fracture confirmed on CT

Availability of complete preoperative radiographs, CT, and MRI

Exclusion Criteria:

• Fractures other than Schatzker type IV

Wahlquist type A fractures

Ipsilateral distal femoral, tibial shaft, or ankle fractures

Previous surgery of the ipsilateral knee

Advanced osteoarthritis (Kellgren-Lawrence grade > 3)

Pathologic fractures

Missing key clinical data

Incomplete or poor-quality imaging precluding accurate measurement

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
fracture dislocations; Fracture-dislocation (including subluxation) was defined only when there was clear tibiofemoral malalignment or incongruity on preoperative imaging, including lateral tibiofemoral subluxation or dislocation on coronal CT and three-dimensional reconstruction, characterized by complete or partial loss of normal alignment between the lateral tibial plateau and the corresponding femoral condyle. MRI findings, were used as supportive evidence, including lateral translation of the lateral tibial plateau with associated compression, deformation, or abnormal course of the lateral collateral ligament	Behavioral: Is it dislocation?; No study intervention was assigned. This study is a retrospective observational case-control study based on review of existing medical records and preoperative imaging data (radiographs, CT, and MRI) of patients with Schatzker type IV tibial plateau fractures. All patients received standard clinical care determined by the treating surgeons, and no additional procedures or treatments were performed for research purposes.
non fracture dislocations; Fracture displacement alone, without clear tibiofemoral malalignment was not considered sufficient for classification as fracture-dislocation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Presence of fracture-dislocation in Schatzker type IV tibial plateau fractures	Fracture-dislocation status determined by preoperative CT, 3D reconstruction, and MRI review	1year
Presence of fracture-dislocation in Schatzker type IV tibial plateau fractures	Fracture-dislocation status determined by preoperative CT, 3D reconstruction, and MRI review	At baseline (preoperative imaging assessment)

Collaborators and Investigators

• Sponsor: Second Affiliated Hospital of Soochow University

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2019
• Primary Completion (Actual): January 1, 2025
• Study Completion (Actual): January 1, 2025

Study Registration Dates

• First Submitted: March 10, 2026
• First Submitted That Met QC Criteria: March 14, 2026
• First Posted (Actual): March 19, 2026

Study Record Updates

• Last Update Posted (Actual): March 19, 2026
• Last Update Submitted That Met QC Criteria: March 14, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Knee Fractures; Wounds and Injuries; Leg Injuries; Fractures, Bone; Knee Injuries; Tibial Fractures; Tibial Plateau Fractures
• Other Study ID Numbers: JD-HG-2026-011

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No