Abstract
OBJECTIVE: To analyze the Schatzker classification and related epidemiological situation of posterolateral tibial plateau fractures (PTPFs), and analyze the curative effect of different surgical approaches and internal fixation methods according to the subtype of PTPFs, to provide a strategic basis for clinicians to treat posterolateral plateau fractures. METHODS: A comprehensive search was conducted across the PubMed, Embase, Cochrane Library, and Web of Science databases to identify PTPFs between 2000 and 2024. The epidemiological data related to PTPFs, including its injury reason, Schatzker and OTA/AO classification, combined injury, complication, fixation methods, function evaluation methods, and other data, were manually screened and retrieved for comparative analysis. The data were analyzed by SPSS 27.0, and the quality of evidence was evaluated according to the MINORS (Methodological Index for Non-Randomized Studies) evaluation tool. RESULTS: Among PTPFs, the common causes of injury were traffic accidents and falls (71.2%, 238/334 vs 23.9%, 80/334), and the most common complications were ligament (ACL, etc.) and meniscus injury (33.6%, 110/327 vs 28.7%, 94/327). Schatzker type II accounted for 50.5-73.7% and type III accounted for 22.8-43.9%. More than half of PTPF fixation can be completed by placing an L-shaped rafting plate (+ screws) through an anterolateral approach. In some situations, fibula neck osteotomies were performed and all healed. The overall excellent and good rate of all internal fixation systems was 0.82 [0.69, 0.95], the excellent and good rate of plates was 0.9 [0.82, 0.98], and the excellent and good rate of absorbable screws was 0.85 [0.75, 0.96]. HSS score was most widely used in postoperative functional evaluation, and reduction loss (22.2%) was the most common postoperative complication. CONCLUSION: Schatzker type II is the most common type in PTPFs. More than half of PTPF fixation can be completed by placing an L-shaped rafting plate (+ screws) through an extended anterolateral approach, especially for PTPFs involving Zone I-II. LEVEL OF EVIDENCE: Level I.