Retrospective analysis of 514 cases of tibial plateau fractures based on morphology and injury mechanism

Kehan Hua,Yejun Zha,Yujiang Mao,Bosong Zhang,Chen Chen,Xieyuan Jiang

doi:10.1186/s13018-019-1321-8

Abstract

BackgroundTibial plateau fractures remain a clinical challenge due to the complexity of the fracture patterns which have been repeatedly categorized by many researchers. However, limitations do exist in some respects. So we aimed to reclassify tibial plateau fractures based on injury mechanism and morphological characteristics.MethodsFive hundred fourteen cases of tibial plateau fractures were enrolled. The X-rays and CT scans were analyzed.ResultsAccording to our observation and analysis, tibial plateau fractures can be categorized into the following six types: (1) Lateral condylar fractures (axial force applied while knee extending in valgus position). Two hundred fifty-one cases were included (48.83%). (2) Fracture dislocation (multiple forces especially rotational stress while knee extending). Fifty-five out of 514 cases belong to this pattern (10.70%). Correction of the subluxation remains primary and crucial during surgical procedures. (3) Simple medial condylar fractures (axial force applied while knee extending in varus position). One third of which were associated with an avulsion fracture of fibular head. Fifteen cases were included (2.92%). (4) Bicondylar fractures (axial forces applied while knee extending). One hundred twelve cases were included (21.79%). Surgical algorithm greatly depends on soft tissue conditions. (5) Posterior condylar fractures (axial stress applied while knee flexing). Sixty-five cases were seen in our study (12.65%), most of which were associated with an avulsion fracture of the intercondylar eminence (49/65, 75.38%). The fracture of posteromedial part, posterolateral part, and intercondylar eminence forms a unique pattern of injury defined as “Posterior Condylar Triad.” (6) Anterior condylar compression fractures (axial, varus, or valgus forces applied while knee overextending). Posterior structural complexes, crucial ligaments, or even popliteal arteries are prone to be damaged. Sixteen cases were identified (3.11%).ConclusionOur classification system has instructive significance in overall preoperative evaluation of fracture features and soft tissue problems as well as guiding clinical management for better functional outcomes.

Highlights

Tibial plateau fractures remain a clinical challenge due to the complexity of the fracture patterns which have been repeatedly categorized by many researchers
Schatzker et al [2] categorized tibial plateau fractures into six different types from I to VI based on the site, the morphology of the fractures, and the overall prognosis
According to fracture morphology and injury mechanism, tibial plateau fractures can be reclassified into six different types

Summary

Introduction

Tibial plateau fractures remain a clinical challenge due to the complexity of the fracture patterns which have been repeatedly categorized by many researchers. Schatzker et al [2] categorized tibial plateau fractures into six different types from I to VI based on the site (medial condyle, lateral condyle, and metaphysis), the morphology (split and depression) of the fractures, and the overall prognosis Luo et al [6] introduced the “three-column concept” based on the transverse view of CT scans, defined as the lateral, medial, and posterior column This was an important advance in the classification and treatment of tibial plateau fractures as it emphasized the significance of the posterior pillar which filled the vacancy for certain types of fracture configurations that may not conform to the traditional Schatzker classification. In order to improve the classification system for tibial plateau fractures, we retrospectively collected and analyzed X-rays and CT scans of 514 cases, and reclassified the fractures based on morphology and injury mechanism

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Discussion

Conclusion