Clinical features and treatment of “Non-dislocated hyperextension tibial plateau fracture”

Abstract

Background: To explore the epidemiological characteristics, clinical characteristics, treatment strategies, and clinical results of non-dislocated hyperextension tibial plateau fracture. Method: A total of 25 cases of non-dislocated hyperextension tibial plateau fracture patients were collected (12 males and 13 females), aged 27-79 years. Preoperative tibial plateau posterior slope angle was − 10~0°(average − 5.2°). Preoperative MRI showed 5 cases of MCL injury, 3 cases of PLC complex injury, and 2 cases of PLC + PCL injury. The change of tibial plateau posterior slope angle was more than 10°in patients with ligament injury, and the patients with a tibial plateau posterior slope angle change less than 10°had no ligament injury; 6 patients with simple column fracture had a ligament injury, 2 patients with bilateral column fracture had a ligament injury, and 2 patients with three column fracture had a ligament injury. Results: Patients were followed up for 12-24 months (average 16.4 months). The operative time was 65-180 min (average 124 min), and the blood loss was 20-200 ml (average 106 ml). The plate was placed on the anterior part of tibial plateau. Evaluation of postoperative fracture reduction was as follows: 20 cases reached anatomic reduction, 5 cases reached good reduction (between 2 and 5 mm articular surface collapse), and the excellent rate of fracture reduction was 100%. The fracture healing time was 3-6 months (average 3.3 months). The postoperative knee Rasmussen score was 18-29 (average 24.9), and the postoperative knee joint mobility was 90-130°(average 118°). Two patients suffered superficial infection. Conclusions: The main imaging characteristic of "non-dislocated hyperextension tibial plateau fracture" is the change of tibial plateau posterior slope angle. The injury of single anteromedial column/anterolateral column fracture is easy to combine with "diagonal" injury, and when the tPSA changes more than 10°, it is easy to be combined with ligament injury. By reducing the joint articular surface and lower limb force line, repairing the soft tissue structure, and reconstructing the knee joint stability, we can get satisfactory results. Trial registration: It was a retrospective study. This study was consistent with the ethical standards of the Second Affiliated Hospital of Zhejiang University Medical College and was approved by the hospital ethics committee and the trial registration number of our hospital was 20180145.

Clinical efficacy of hyperextension bicondylar tibial plateau fractures fixed by medial and lateral dual plates and spinal cage

“…However, dual incisions also require excessive stripping of soft tissue to expose the anterior compression fracture [9]. Therefore, a modi ed midline incision is recommended for fractures with little posterior displacement or tension failure, although this increases the frequency of soft tissue complications such as necrosis and infection [19,20]. Hence, anterolateral and posteromedial dual incisions are recommended when the posterior tibial cortex is displaced over 2 mm, the posterior hinge need to be reconstructed.…”

Different patterns of tibial plateau fractures associated with hyperextension injuries of the knee with or without varus/valgus component

“…This anatomically oriented classification including 2 columns and 4 quadrants can be easily remembered and used, and previous literature [ 13 ] showed good intraobserver and interobserver reliability, the mean Kappa value was 0.939 and 0.955, respectively. Second, it may facilitate hyperextensive TPF research because it contains all of the hyperextension TPF patterns reported in previous literature [ 2 , 3 , 6 , 10 , 23 ] and each fracture pattern only matches 1 certain type. Finally, it helps us choose suitable operative approaches for fracture fixation.…”

“…[ 8 ] Currently, because of a lack of a commonly accepted classification system based on anatomic fracture morphology, some confusing terms are used to indicate fracture subtypes caused by hyperextension injuries, such as “reverse Segond” fractures [ 9 ] and non-dislocated hyperextension TPFs. [ 10 ]…”

“…morphology, some confusing terms are used to indicate fracture subtypes caused by hyperextension injuries, such as "reverse Segond" fractures [9] and non-dislocated hyperextension TPFs. [10] The purpose of this retrospective study, therefore, is to introduce a new systematic classification for hyperextension TPFs based on CT images and to illustrate the correlation between anterior compression fractures, posterior tension fractures and proximal fibular avulsion fractures (PFAFs).…”

Finite element analysis and clinical efficacy of hyperextension bicondylar tibial plateau fractures fixed by medial and lateral dual plates and spinal cage

“…Therefore, a modi ed midline incision is recommended for fractures with little posterior displacement or tension failure, although this increases the frequency of soft tissue complications such as necrosis and infection [23,24]. Hence, anterolateral and posteromedial dual incisions are recommended when the posterior tibial cortex is displaced over 2 mm, the posterior hinge need to be reconstructed.…”