Vertex-based classification for tibial plateau fractures: Guiding the surgical approach through CT mapping

Objectives : To introduce a vertex-based classification system for tibial plateau fractures that links CT-defined fracture geometry to surgical approach selection. Design : Retrospective diagnostic study. Setting : Urban academic level one trauma center. Patient selection criteria : Patients 18 years or older with surgically treated tibial plateau fractures between 2025 and 2024, having available preoperative CT scans. Outcome measures and comparisons : Distribution of fracture vertices across predefined anatomical zones and corresponding surgical approaches. Results : Among 103 patients, vertex mapping revealed the most common location was the lateral anterior zone (55.3%), followed by medial posterior (14.6%) and posterior medial (12.6%). Each zone correlated with a preferred surgical approach, facilitating procedural planning. Fracture and depression maps were consistent with known biomechanical patterns. Conclusions : This CT-guides classification identifies mechanical relevant fracture vertices, supporting the selection of optimal surgical approaches. It enhances current classification systems by incorporating operative strategy into preoperative planning. Level of Evidence: Level III, diagnostic study.