Widening is a predictive factor of bucket handle tear in tibial plateau fractures.

Abstract

It is well known that tibial plateau fractures have an association with soft tissue injuries. However, as far as the authors are aware, there has been no literature specifically on the incidence of bucket handle meniscal tears in patients with tibial plateau fractures. Bucket handle tears are often symptomatic and amenable to repair if detected early. Our objective was therefore to determine the incidence of bucket handle tears specifically in tibial plateau fractures and identify radiographic features which are suggestive of bucket handle tears. Data for 88 consecutive patients with tibial plateau fractures in a major trauma centre over a two-year period were analysed. Clinical records were reviewed to identify injuries with an associated bucket handle tear. Pre-operative computerised tomography was reviewed. Monovariant and multivariant analyses were conducted to identify radiographic predictive features. The results showed a 20% incidence of soft tissue injuries in concurrence with the existing literature. In addition, there was found to be a 10% incidence of meniscal bucket handle tears. Articular widening of > 8mm was found to be a unique significant predictor of bucket handle tears. It is essential to bear in mind the association with soft tissue injuries in tibial plateau fractures and the incidence of bucket handle tears in particular. The radiographic feature of articular widening should alert the clinician to the possibility of this injury. This will enable appropriate investigations and surgical planning to be carried out in order to improve patient management and outcomes.