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Introduction <p>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.</p> Methods <p>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 mm<sup>2</sup>). Fractures were classified by injury mechanism (low- vs. high-energy) and HU thresholds were defined as poor (&lt; 110) or normal (&gt; 160). Clinical outcomes included major complications, reoperations, range of motion, Visual Analog Scale (VAS) pain scores, and Short Musculoskeletal Function Assessment (SMFA) scores.</p> Results <p>Low-energy fractures (<i>n</i> = 96) had significantly lower HU values (113.9 vs. 150.9, <i>p</i> &lt; 0.0001) across all planes. No significant differences were found in clinical outcomes.</p> Conclusion <p>Low-energy Schatzker IV–VI fractures indicate poor bone quality and may represent “fragility fractures” requiring further evaluation.</p>

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

  • 期刊论文

  • 发表日期：

    2026年3月7日

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  • Amaya Contractor,
  • Nina Fisher,
  • Abhishek Ganta,
  • Sanjit Konda,
  • Kenneth Egol

摘要

Introduction

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.

Methods

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.

Results

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.

Conclusion

Low-energy Schatzker IV–VI fractures indicate poor bone quality and may represent “fragility fractures” requiring further evaluation.