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

Abstract

Background Tibial 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. Methods Five hundred fourteen cases of tibial plateau fractures were enrolled. The X-rays and CT scans were analyzed. Results According 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%). Conclusion Our 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.

Why address posterior tibial plateau fractures?

“…A strong association was found here between posterior condylar fractures and evidence of softtissue injuries (e.g. avulsion fractures of the intercondylar eminence) [23]. Merging fracture-mapping with fracture-mechanism classification, Xie et al aimed to combine the best of both concepts [13].…”

“…Adding hyperextension to Wang' updated three-column concept, they defined six injury categories: force vector in the sagittal plane (flexion/extension/hyperextension) and coronal plane (valgus/varus). In conjunction with Hua et al an association between flexion-varus fractures, and anterior cruciate ligament (ACL) injury was established [8,23].…”

“…Based on the three-column classification, Wang et al introduced the updated three-column concept, which incorporates trauma mechanism (flexion/extension and varus/valgus), in order to guide surgical decision making [8]. More recently, Hua et al evaluated a more extensive injury-mechanism centered classification system, wherein six main fracture types were defined: lateral condylar fracture (valgus type), fracture dislocation (complex force type), simple medial condylar fracture (varus type), bicondylar fracture (extension type), posterior condylar fracture (flexion type) and anterior condylar compression fracture (hyperextension type) [23]. The main strength of this study is the attention to collateral injuries, such as avulsion fractures of the intercondylar eminence and fibular head.…”

Tibial Plateau Fracture

“…The system divides tibial plateau fractures into six types designated from I to VI. The main limitation of this classification system is its failure to account for many important tibial plateau fracture patterns [19][20][21][22][23]. The Schatzker classification was based on the use of AP plain radiographs of the knee and because of this it is primarily beneficial in analysis of sagittal fracture lines on the medial and lateral plateaus leaving out fractures in the coronal plane.…”

Correlation Between CT Images of Lateral Plateau and Lateral Meniscus Injuries in Patients With Schatzker II Tibial Plateau Fractures：A Retrospective Study

“…As we all know, tibial plateau fractures are usually accompanied with injuries of soft tissues which mainly including medial and lateral meniscus, medial and lateral collateral ligaments, and anterior and posterior cruciate ligaments. Under these conditions, early diagnosis and treatment of meniscus and ligament injuries can often provide a better prognosis of knee function [1][2][3]. In clinic, it is noticeable that there exists a limit of physical examinations on patients due to joint pain, swelling, and con ned activity.…”