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Purposes InSchatzkerclassificationoftibialplateaufracture,fracturetypes(ItoⅥ)areassignedinpresumedincreasing orderofseverity.However,thereisaclinicalrecognitionthatitisSchatzkertypeⅣthathastheworstprognosis. Thisisprobablybecauseitlacksacleardefinitionandhighvariabilityinfracturepattern.Weclarifiedtheconcept ofSchatzkertypeⅣfractureandproposedanewsubclassificationsystembasedonCT2-Dand3-D reconstruction. Methods WedefineSchatzkertypeⅣtibialplateaufractureasAO/OTA41type-Bfracture(partialarticular),andpartialor totalmedialplateauisinvolved,butatleasttheanterolateralquadrantisleftintact.Theimagesof42fractures(42patients)wereevaluated.Thefractureswerefurtherdividedintotwogroups:Group Iistheclassicmedial unicondylarfractures,and Group Ⅱismorecomplicatedvariantsinvolvingbicondylar,characterizedbymedial condylefractureswithlateralplateauextension,usuallyarticularimpactionofthecentro-posteriorlateralplateau. Results Twelvecasesinvolvedonlythemedialcondyles(29%),andthirtyinvolvedboththemedialandlateralcondyles(71%).Themostcommonpatternisbicondylarposteromedialplateaufracturewithposterolateralquadrant depression(bicondylarposteriorfractures,14cases,33%)andtotalmedialcondylefracturewithposterolateral quadrantdepression(13cases,31%).Theisolatedunicondylarposteromedialsplitfractureisuncommon(2cases, 5%). Conclusions CTreconstructionenhancestheunderstandingoffractureanatomyandfragmentsrelationship.Itiscrucialto recognizetheextendedbicondylarvariantsfromtheclassicunicondylarSchatzkertypeⅣfracturepatterns.