Is there a difference between the incidence of subtypes of tibial plateau fractures between six different level 1, level 2 and level 3 trauma centers in the Netherlands?

TL;DR

This study examines how different types of tibial plateau fractures vary across trauma centers in the Netherlands, finding that higher-level centers treat more severe fractures.

Contribution

The study reveals differences in fracture subtypes and trauma mechanisms across trauma center levels in the Netherlands.

Findings

Level 1 trauma centers treated more high-energy trauma cases, predominantly Schatzker 6 fractures.

Level 2 and 3 centers handled more low-energy traumas, mainly Schatzker 2 fractures.

Moderate interobserver agreement was found for fracture classification systems.

Abstract

Tibial plateau fractures can present as different subtypes due to variation in patient characteristics and trauma mechanisms. Insight in the fracture pattern and classification is critical for adequate treatment.This study aims to assess the incidence of tibial plateau fracture subtypes among various levels of trauma centers in the Netherlands, to explore potential variations in fracture patterns and fracture classifications between these centers.

Over a one-year period data was collected from six Dutch trauma centers representing different levels of trauma care. Fractures were classified using both Schatzker and Luo’s systems. Interobserver agreement was calculated to evaluate the consistency of fracture classification among surgeons.

We included 115 patients treated for a tibial plateau fracture across six different hospitals. The mean patient age was 54 years, ranging from 17 to 85 years. Differences in fracture incidence and mechanisms of injury across trauma centers were revealed; Level 1 trauma centers treated a higher proportion of high-energy trauma cases, predominantly Schatzker 6 fractures, while level 2 and 3 centers dealt with more low-energy traumas, particularly Schatzker 2 fractures. Interobserver agreement for both classification systems was moderate, indicating challenges in classifying tibial plateau fractures accurately.

This study sheds light on the diverse distribution of subtypes of tibial plateau fractures in Dutch trauma centers. Level 1 centers are treating younger, high-energy trauma patients, whereas level 2 and 3 centers handle more low-energy traumas, predominantly Schatzker 2 fractures.

METC Oost-Nederland: 2021–13,184.

The online version contains supplementary material available at 10.1186/s12891-025-08383-8.