Fibular head avulsion fractures accompanying operative treated medial tibial plateau fractures

Tarvo Sillat,Seppo K Koskinen,Antti Mustonen,Markus Parkkinen,Rami Madanat,Jan Lindahl,Tatu J Mäkinen

doi:10.1007/s00256-019-03191-3

Tarvo Sillat, Seppo K Koskinen + Show 5 more

Open Access

https://doi.org/10.1007/s00256-019-03191-3

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Abstract

ObjectiveThe aims of this work are to determine how frequently medial tibial plateau fractures are accompanied by fibular head avulsion fractures and evaluate the sensitivity of radiographs detecting them, and also to assess if the presence of fibular fracture is correlated with long-term functional outcome and peroneal nerve damage.Materials and methodsA retrospective chart review of operated patients with medial tibial plateau fractures at level I trauma center during 2002–2008 was performed. From 63 patients imaged preoperatively, 59 had CT and radiographs, three had only CT, and one only radiograph. The presence and fragment size of fibular fracture were retrospectively evaluated. Body mass index (BMI) and functional outcome measurements (the Modified Lysholm knee score and WOMAC) were available for 46 patients.ResultsFourteen out of 63 patients (22.2%) had fibular fractures. Of the 59 patients with both CT and radiographs, 12 had fibular fractures, and of these, nine were seen with both modalities and three only in CT. Functional scores were available for ten patients with fibular fracture. Patients with fibular fracture seen on radiographs had a significantly higher score on WOMAC function (26 vs. 7; p = 0.027). The patients with fibular fractures had also higher BMI (p = 0.035). Of the six patients with peroneal nerve damage, 50% had fibular fracture.ConclusionsIn patients with operatively treated medial tibial plateau fracture, the fibular fractures are relatively common. Detecting it is important, as it may be associated with worse functional scores and peroneal nerve paresis. Some fibular fractures may remain undetected on radiographs, hence preoperative CT is recommended.

Highlights

A recent study found that initial articular depression of the plateau measured from preoperative CT scans was a significant predictor of developing post-traumatic OA after operatively treated medial plateau fracture [7]
There was no difference between fractures found by general and specialized MSK radiologist
The medial plateau fracture type was according to the AO/ OTA classification B1.2 in one case (7%), B3.2 in seven cases (50%), and B3.3 in six cases (43%) (Table 1)

Summary

Introduction

Isolated lateral plateau is most commonly involved (55–70%), followed by medial plateau (10–25%) and bicondylar fractures (15%) [3]. The isolated medial plateau fractures are relatively rare, they have been regarded to have the worst prognosis [4]. This may be due to the normal biomechanics of the knee, where medial compartment transmits usually more loading than the lateral one [5]. Approximately half of the medial plateau fractures are caused by high-energy trauma [6, 7]. A recent study found that initial articular depression of the plateau measured from preoperative CT scans was a significant predictor of developing post-traumatic OA after operatively treated medial plateau fracture [7]

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