Tibia plateau fracture mapping and its influence on fracture fixation

Abstract

Background Tibial plateau fracture classifications are based on anteroposterior radiographs. Precontoured locking plates are commonly used to treat such fractures. The aims of this study are to: (1) describe tibial plateau fracture anatomy in the axial plane and (2) assess whether current plating systems allow screws to be placed suitably. Materials and methods A graphical tibial plateau template was developed. One hundred twenty-five tibial plateau fractures (four bilateral) were reviewed (80 men, 41 women; average age 45.5 years, range 21–77.7 years). The axial computed tomography (CT) slice 0.3–0.5 mm below the medial articular surface was reviewed in all cases. Fracture lines were drawn on the template. Four lateral locking plates were placed against a cadaveric adult tibia. Based on the projected screw directions, suitable fracture patterns were identified. Fractures were considered “suitable” if the screws passed 90 ± 22° to the fracture line. Results Two hundred sixty-one different fracture lines were identified. One hundred thirty-four fractures involved the lateral plateau; 96 were suitable for lateral plating. Ninety fractures involved the medial plateau, 82 were treatable using the various plate positions on medial-posterior aspect of the medial plateau. Thirty-seven fractures were bicondylar; 20 were treatable with a posteromedial plate. Conclusions Tibial plateau fractures follow consistent patterns, with most lateral and medial plateau fracture lines being in the sagittal plane, although there is greater variation medially. Positioning of modern locking plates will deal effectively with 72 % of all lateral plateau fractures and 91 % of medial plateau fractures. Level of evidence Level 3.

Fracture mapping of complex intra-articular calcaneal fractures

“…Fracture mapping can record the size, shapes, numbers, and orientations of fracture fragments, and help surgeons determine the optimal treatment (5). To date, fracture mapping has been applied to scapular, tibial, hip, and acetabular fractures (6)(7)(8)(9)(10)(11). However, there have been no reports concerning fracture mapping for the treatment of calcaneal fractures.…”

Fracture patterns in midshaft clavicle fractures

“…The usefulness of fracture mapping has undoubtedly contributed to the understanding and treatment of mapped fractures, including the tibia plateau (6), olecranon (7) and scapula (8). An improved understanding of fracture morphology, based on computed tomography (CT) and quantitative 3-dimensional CT (3D CT) analysis of the clavicle, might guide decision-making and implant development.…”

Dual plating or dual plating combined with compression bolts for bicondylar tibial plateau fractures: a retrospective comparative study

“…However, the treatment of bicondylar TPFs remains controversial. Many scholars have suggested that isolated lateral locking plates, dual plating and additional posterior buttress plating can all be used to treat bicondylar TPFs 6 , 9 , 18 , 19 . At present, although lateral locking plates are widely used in bicondylar TPFs, an additional medial support plate is often required when the fragments of the medial condyle are small, comminuted, osteoporotic, or have coronal fractures 7 , 20 , 21 .…”