Computed tomographic classification of posterior condylar tibial plateau fractures

Abstract

To study the new computed tomographic (CT) classification, surgical approaches and clinical efficacy of posterior condylar tibial plateau fractures. From January 2006 to July 2009, a total of 39 patients of posterior condylar tibial plateau fractures were treated by posteromedial and posterolateral knee approaches. There were 23 males and 16 females. The mean age was 41.6 years old (range: 28 - 68). Among all patients, the causes were traffic accidents (n = 26), falls (n = 9) and other injuries (n = 4). By CT classification, there were type I with posteromedial condylar tibial plateau split fracture (n = 7), type II with posterolateral condylar tibial plateau split fracture (n = 5), type III with posterolateral condylar tibial plateau depression fracture (n = 11), type IV with posterolateral condylar tibial plateau split depression fracture (n = 2) and type V with posteromedial split and posterolateral condylar tibial plateau depression fracture (n = 14). The mean follow-up period was 18.1 months (range: 12 - 30). The radiographic bony union time was 11 - 16 weeks (mean: 15.2) and the full weight-bearing time 12 - 20 weeks (mean: 15.6). No infection, knee varus/valgus, nerve injury or screw loosening/breakage was found. Bony union was achieved in all cases. According to the Rasmussen functional scoring, the results were excellent in 20, good in 14 and fair in 5. And the excellent and good rate was 87.2%. The radiological results were graded with the Rasmussen score to evaluate the reduction of fracture. The outcome was excellent in 28, good in 8 and fair in 3. And the excellent and good rate was 92.3%. This new CT classification scheme of posterior condylar tibial plateau fractures can significantly improve the reliability, guide the clinicians to select appropriate treatment plans and design an ideal regimen of operative approach and internal fixation.