Low energy Schatzker IV, V, and VI tibial plateau fractures are a marker of local poor bone quality.

Abstract

Hounsfield units (HU) are a validated marker of bone mineral density. This study aimed to determine whether low-energy Schatzker IV, V and VI tibial plateau fractures are associated with altered bone quality. 152 patients who underwent operative repair of Schatzker IV (44), V (37) and VI (71) tibial plateau fractures were identified. HU values were measured at the proximal tibia metaphysis on mid-axial, mid-coronal and mid-sagittal CT images using a circular region of interest (ROI; ≥35 mm²). Fractures were classified by injury mechanism (low- vs. high-energy) and HU thresholds were defined as poor (< 110) or normal (> 160). Clinical outcomes included major complications, reoperations, range of motion, Visual Analog Scale (VAS) pain scores, and Short Musculoskeletal Function Assessment (SMFA) scores. Low-energy fractures (n = 96) had significantly lower HU values (113.9 vs. 150.9, p < 0.0001) across all planes. No significant differences were found in clinical outcomes. Low-energy Schatzker IV-VI fractures indicate poor bone quality and may represent "fragility fractures" requiring further evaluation.