Functional outcome of intra-articular tibial plateau fractures: the impact of posterior column fractures

Berg, J. van den; Reul, Maike; Cardozo, Menno Nunes; Starovoyt, Anastasiya; Geusens, Eric; Nijs, Stefaan; Hoekstra, Harm

doi:10.1007/s00264-017-3566-3

Cited by 53 publications

(58 citation statements)

References 26 publications

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“…There is growing evidence that posterior tibial plateau fractures affect the functional outcome [17, 34]. The reported incidence of posterior tibial plateau fractures ranges from 28.8 to 70.7% [9, 15]. The results of this study found a clear indication that the posterior column fracture was also associated with high morbidity in elderly patients (67.58%), and the PL sub-column (62.69%) was more often involved than the PM sub-column (37.92%).…”

Section: Discussionmentioning

confidence: 99%

“…Because both classifications provide only two-dimensional information of the fracture, a CT-based three-column classification (TCC) would be a good supplement for evaluation [8]. There were already numerous studies which indicated that implementation of the three-column classification (TCC) might improve the surgical outcome of cases of TPFs [9, 10]. This is the first time that the TCC has been used to evaluate the morphological features of tibial plateau fractures in a large sample size of elderly patients.…”

Section: Introductionmentioning

confidence: 99%

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Tibial plateau fractures in elderly people: an institutional retrospective study

Sun

Shu

et al. 2018

J Orthop Surg Res

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BackgroundTibial plateau fractures are the most common intra-articular fractures, which require careful evaluation and preoperative planning. The treatment of tibial plateau fractures in elderly patients is challenging, and the comprehension of epidemiology and morphology can be helpful. This study described the characteristics of geriatric tibial plateau fractures.MethodsA total of 327 (23.24%) patients aged ≥60 years were reviewed in our level one trauma center over a 4-year period (from January 2013 to November 2016). The following parameters were collected and evaluated: (1) demographic data, (2) injury mechanisms and (3) fracture classifications.ResultsFemales accounted for 60.86% in all included elderly patients. Electric-bike accidents were the cause of 32.42% of all these injuries, and 39.62% of these led to high-energy injuries. The most common type of fracture was Schatzker II (54.74%). According to the three-column classification, single lateral column fracture (28.75%) and four-quadrant fracture (involving lateral, medial, posterolateral and posteromedial fractures) (23.24%) were the two most frequent patterns. In all cases, 67.58% involved the posterior column, and the prevalence of posterolateral and posteromedial fractures were 62.69% and 37.92% respectively. Isolated posterior column fractures accounted for 12.54% of patients in total, which mostly consisted of posterolateral fracture in older females (85.37%).ConclusionsThe majority of elderly patients with tibial plateau fractures are females, and Electric-bike accidents are an important cause of injury. Geriatric tibial plateau fractures have unique distribution in classification.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Tibial plateau fractures in elderly people: an institutional retrospective study

Sun

Shu

et al. 2018

J Orthop Surg Res

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“…T 1 WI and T 2 WI can have an elevated signal. T 2 WI showed the best results: A rough edge, thickening and other signs[ 19 ]. According to the relevant statistics, the incidence of joint capsule/articular cavity effusion at the time of fracture of the tibial plateau can reach 90%.…”

Section: Discussionmentioning

confidence: 99%

Comparison between computed tomography and magnetic resonance imaging in clinical diagnosis and treatment of tibial platform fractures

Liu

Wang

Zhang

et al. 2020

WJCC

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BACKGROUND Tibial plateau fracture is one of the common fracture types. It occurs mainly in teenagers and is usually caused by a fall. After the occurrence of fracture, knee swelling, pain, limited activity, etc . greatly affect the patient’s exercise habits and lifestyle. X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) were used in this examination. X-rays are relatively new and easy to operate. However, there are some errors in the observation of fracture collapse and fracture displacement. In recent years, CT and MRI have been actively used to diagnose various types of clinical fractures. They have more diagnostic power than X-ray film. However, some scholars believe that CT is also prone to errors in clinical application. The volume effect leads to missed diagnosis and misdiagnosis in some cases, while the multidirection scanning of MRI technology can effectively overcome the shortcomings of CT. To facilitate the selection of clinical examination regimens, this study further observed the diagnostic ability of these two regimens in the diagnosis of tibial plateau fractures. AIM To explore the value of nuclear MRI and CT in the clinical diagnosis of tibial plateau fractures. METHODS A total of 120 patients with tibial plateau fractures admitted from September 2017 to August 2019 were included. All patients were examined by nuclear MRI and CT scanning. The results were sent to senior physicians in our hospital to complete the diagnosis. RESULTS Nuclear magnetic resonance showed the same effects as CT in four aspects: fracture displacement, bone defect, fracture site and fracture comminution. There was no significant difference in the score data ( P > 0.05). Nuclear magnetic resonance and CT tended to be consistent in the B3, C2 and C3 fracture diagnosis coincidence rate, combined injury detection rate and fracture detection rate. The diagnostic coincidence rate of type B1, B2 and C1 fractures and the accuracy rate of overall fracture classification indicated that the MRI technique was significantly better than that of CT ( P > 0.05). CONCLUSION MRI and CT have good diagnostic typing in the diagnosis of tibial plateau fractures, but MRI is more accurate and may be preferred.

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“…Die Behandlung und Fixierung der posterioren Frakturen wird zunehmend als wichtiger prognostischer Faktor erkannt [3]. Wir konnten beobachten, dass nicht erkannte oder nicht behandelte Frakturen des posterioren Pfeilers und sagittale Achsfehlstellung im Vergleich zu Tibiaplateaufrakturen ohne Beteiligung des posterioren Pfeilers zu signifikant schlechteren Outcome Scores führen [4].…”

Section: Methodsunclassified

Der kombinierte posteromediale und anterolaterale Zugang in der „floating“-Position zur operativen Versorgung der Zwei-Pfeiler-Tibiakopffraktur

Reul

Hoekstra

2017

Z Orthop Unfall

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The posterior tibial plateau is often affected in intra-articular tibial fractures. Moreover, treating these posterior fractures is recognised as an important prognostic factor. Open reduction and internal fixation of lateral and posterior two column tibial plateau fractures can be achieved via a combined reversed L-shape approach and an anterolateral approach in the floating position without intraoperative repositioning of the patient. The operative procedure starts in the posterior position with visualisation of the posterior column after lateral retraction of the medial head of the M. gastrocnemius. The posterior fragment is then reduced and fixated. This is followed by reversed patient tilt, and slight flexion and varus stress on the knee. An anterolateral approach is performed with visualisation of the lateral column, direct reduction and internal fixation of the lateral tibia plateau. Since June 2014, 14 two column tibial plateau fracture patients with posterior and lateral column involvement have been treated according to this technique. The median follow-up was 306 days (IQR 194 - 438); 1 patient was lost to follow-up. During the last outpatient visit, 7 patients reported pain to some extent. At a median of 110 days (IQR 96 - 181), 10 patients showed a full range of motion. One deep infection was noted postoperatively. At the 3 to 4 month postoperative CT control, 10 of 14 patients showed successful reduction with restored alignment, whereas in 8 of 14 patients there was a congruent articular surface without significant articular steps (< 2 mm). We have demonstrated that the surgical treatment of two column fractures of posterior and lateral tibial plateau fractures is technically possible via a combined posterior reversed L-shaped and anterolateral approach in a floating position without the necessity of intraoperatively repositioning of the patient. Although the number of patients was limited, the clinical and radiographic outcome was rather good.

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Functional outcome of intra-articular tibial plateau fractures: the impact of posterior column fractures

Abstract: 3.

Cited by 53 publications

References 26 publications

Tibial plateau fractures in elderly people: an institutional retrospective study

Tibial plateau fractures in elderly people: an institutional retrospective study

Comparison between computed tomography and magnetic resonance imaging in clinical diagnosis and treatment of tibial platform fractures

Der kombinierte posteromediale und anterolaterale Zugang in der „floating“-Position zur operativen Versorgung der Zwei-Pfeiler-Tibiakopffraktur

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