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Shimizu K, Takegami Y, Tokutake K, Naruse K, Sudo Y, Matsubara Y, Imagama S. What factors are associated with loss of alignment after open reduction and internal fixation for tibial plateau fractures? A retrospective multicenter (TRON group) study. J Orthop Sci 2024; 29:286-291. [PMID: 36575098 DOI: 10.1016/j.jos.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/20/2022] [Accepted: 12/12/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Tibial plateau fractures (TPFs) are one of the most challenging intra-articular fractures to treat. Along with reconstruction of the articular surfaces, appropriate alignment of the knee joints must be obtained and maintained after open reduction and internal fixation (ORIF) for TPFs because loss of alignment (LA) is associated with worse clinical outcomes. We aimed to investigate and clarify the risk factors related to LA after ORIF for TPFs. METHODS This multicenter, retrospective cohort study used data of hospitals of the Trauma Research Group (TRON group) from January 1, 2011, to December 31, 2020. Among 293 TPFs extracted from the database, we evaluated the alignment of the articular surface to the anatomical axis of the tibia in the immediate postoperative and last follow-up radiographs. We defined a change of alignment from the immediate postoperative radiograph as LA. We evaluated the risk factors of LA using univariate and multiple logistic regression analyses. RESULTS LA was observed in 27 fractures (9.2%). In multiple logistic regression analyses, preoperative articular step-off and postoperative condylar widening were statistically associated with LA (OR = 1.1, 95% CI: 1.02-1.19 and P = 0.012; OR = 1.04, 95% CI: 1.00-1.08, P = 0.045, respectively). We calculated the threshold by drawing a receiver operating characteristic curve using the final regression model. The threshold of postoperative widening was 8.2 mm. We divided the 293 TPFs into two groups according to this threshold and determined differences between the two groups using Fisher's exact test. The two groups were statistically significantly different (P = 0.00502). CONCLUSIONS Preoperative articular step-off and postoperative condylar widening could be associated with LA after ORIF for TPFs. We suggest that intraoperative restoration of condylar widening is important for the prevention of malalignment following ORIF for TPF.
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Affiliation(s)
- Keita Shimizu
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Takegami
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Katsuhiro Tokutake
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keita Naruse
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshito Sudo
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuji Matsubara
- Department of Orthopedic Surgery, Kariya TOYOTA General Hospital, Toyota, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Liu Y, Fang R, Tu B, Zhu Z, Zhang C, Ning R. Correlation of preoperative CT imaging shift parameters of the lateral plateau with lateral meniscal injury in Schatzker IV-C tibial plateau fractures. BMC Musculoskelet Disord 2023; 24:793. [PMID: 37803358 PMCID: PMC10557321 DOI: 10.1186/s12891-023-06924-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 09/26/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Schatzker IV-C is a high-energy tibial plateau fracture often accompanied by lateral meniscus injuries. While imaging examinations are routine preoperative measurements, the correlation between CT imaging shift parameters of the lateral plateau and lateral meniscal injury in Schatzker IV-C fractures remains uncovered. METHODS This retrospective study enrolled a total of 60 patients with Schatzker IV-C tibial plateau fractures at the First People's Hospital of Hefei. Prior to surgery, CT imaging was used to measure the numerical values of lateral plateau depression (LPD) and lateral plateau widening (LPW). The degree of lateral meniscus injury was confirmed based on intraoperative direct vision, with patients being classified into meniscus injury and non-meniscus injury groups. Dichotomous logistic regression was employed to evaluate the correlation between LPD, LPW, and lateral meniscus injury, while the optimal cut-off points for predicting lateral meniscal injury with LPD and LPW were determined using receiver operator characteristic (ROC) curves. RESULTS The meniscus injury group exhibited a mean LPD of 15.3 ± 3.5 mm, which was significantly higher than the non-meniscus injury group's mean LPD of 8.4 ± 3.4 mm (P < 0.05). Similarly, the meniscus injury group had a larger mean LPW of 9.4 ± 1.8 mm compared to the non-meniscus injury group's mean LPW of 6.9 ± 0.9 mm (P < 0.05). The optimal cut-off points for predicting lateral meniscal injury were determined to be 8.40 mm for LPD (with a sensitivity of 95%, specificity of 85%, and AUC of 0.898) and 7.90 mm for LPW (with a sensitivity of 75%, specificity of 90%, and AUC of 0.897). CONCLUSIONS Patients with Schatzker IV-C tibial plateau fractures are at a significantly higher risk of lateral meniscal injury when the LPD exceeds 8.40 mm and/or the LPW exceeds 7.90 mm. Our results may provide novel reference metrics for the early diagnosis of lateral meniscal injury in Schatzker IV-C tibial plateau fracture patients when the MRI examination is not available.
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Affiliation(s)
- Yulong Liu
- Department of Orthopedics, The Third Affiliated Hospital of Anhui Medical University, The First People's Hospital of Hefei, 390 Huaihe Road, Hefei, 230061, Anhui, China
| | - Run Fang
- Department of Orthopedics, The Third Affiliated Hospital of Anhui Medical University, The First People's Hospital of Hefei, 390 Huaihe Road, Hefei, 230061, Anhui, China
| | - Bizhi Tu
- Department of Orthopedics, The Third Affiliated Hospital of Anhui Medical University, The First People's Hospital of Hefei, 390 Huaihe Road, Hefei, 230061, Anhui, China
| | - Zheng Zhu
- Department of Orthopedics, The Third Affiliated Hospital of Anhui Medical University, The First People's Hospital of Hefei, 390 Huaihe Road, Hefei, 230061, Anhui, China
| | - Chengnan Zhang
- Department of Orthopedics, The Third Affiliated Hospital of Anhui Medical University, The First People's Hospital of Hefei, 390 Huaihe Road, Hefei, 230061, Anhui, China
| | - Rende Ning
- Department of Orthopedics, The Third Affiliated Hospital of Anhui Medical University, The First People's Hospital of Hefei, 390 Huaihe Road, Hefei, 230061, Anhui, China.
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Lv H, Li W, Wang Y, Chen W, Yan X, Yuwen P, Hou Z, Wang J, Zhang Y. Prediction model for tibial plateau fracture combined with meniscus injury. Front Surg 2023; 10:1095961. [PMID: 37396296 PMCID: PMC10312001 DOI: 10.3389/fsurg.2023.1095961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 06/05/2023] [Indexed: 07/04/2023] Open
Abstract
Purpose To investigate a prediction model of meniscus injury in patients with tibial plateau fracture. Methods This retrospective study enrolled patients with tibial plateau fractures who were treated in the Third Hospital of Hebei Medical University from January 1, 2015, to June 30, 2022. Patients were divided into a development cohort and a validation cohort based on the time-lapse validation method. Patients in each cohort were divided into a group with meniscus injury and a group without meniscus injury. Statistical analysis with Student's t-test for continuous variables and chi square test for categorical variables was performed for patients with and without meniscus injury in the development cohort. Multivariate logistic regression analysis was used to screen the risk factors of tibial plateau combined with meniscal injury, and a clinical prediction model was constructed. Model performance was measured by examining discrimination (Harrell's C-index), calibration (calibration plots), and utility [decision analysis curves (DCA)]. The model was validated internally using bootstrapping and externally by calculating their performance in a validation cohort. Results Five hundred patients (313 [62.6%] males, 187 [37.4%] females) with a mean age of 47.7 ± 13.8 years were eligible and were divided into development (n = 262) and validation (n = 238) cohorts. A total of 284 patients had meniscus injury, including 136 in the development cohort and 148 in the validation cohort We identified high-energy injuries as a risk factor (OR = 1.969, 95%CI 1.131-3.427). Compared with blood type A, patients with blood type B were more likely to experience tibial plateau fracture with meniscus injury (OR = 2.967, 95%CI 1.531-5.748), and office work was a protective factor (OR = 0.279, 95%CI 0.126-0.618). The C-index of the overall survival model was 0.687 (95% CI, 0.623-0.751). Similar C-indices were obtained for external validation [0.700(0.631-0.768)] and internal validation [0.639 (0.638-0.643)]. The model was adequately calibrated and its predictions correlated with the observed outcomes. The DCA curve showed that the model had the best clinical validity when the threshold probability was 0.40 and 0.82. Conclusions Patients with blood type B and high-energy injuries are more likely to have meniscal injury. This may help in clinical trial design and individual clinical decision-making.
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Affiliation(s)
| | | | | | | | | | | | | | - Juan Wang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, ShijiazhuangChina
| | - Yingze Zhang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, ShijiazhuangChina
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Gohla G, Kraus MS, Peyker I, Springer F, Keller G. Diagnostic Accuracy of 128-Slice Single-Source CT for the Detection of Dislocated Bucket Handle Meniscal Tears in the Setting of an Acute Knee Trauma—Correlation with MRI and Arthroscopy. Diagnostics (Basel) 2023; 13:diagnostics13071295. [PMID: 37046513 PMCID: PMC10093062 DOI: 10.3390/diagnostics13071295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/16/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
(1) Background: Meniscal tears are amongst the most common knee injuries. Dislocated bucket handle meniscal tears in particular should receive early intervention. The purpose of this study was to evaluate the diagnostic performance of CT in detecting dislocated bucket handle meniscal tears compared with the gold-standard MRI and arthroscopy. (2) Methods: Retrospectively, 96 consecutive patients underwent clinically indicated CT of the knee for suspected acute traumatic knee injuries (standard study protocol, 120 kV, 90 mAs). Inclusion criteria were the absence of an acute fracture on CT and a timely MRI (<6 months). Corresponding arthroscopy was assessed. Two experienced musculoskeletal radiologists analyzed the images for dislocated bucket handle meniscal tears, associated signs thereof (double posterior cruciate ligament sign, double delta sign, disproportional posterior horn sign), and subjective diagnostic confidence on a 5-point-Likert scale (1 = ‘non-diagnostic image quality’, 5 = ‘very confident’). (3) Results: Dislocated bucket handle meniscal tears were detected on CT by standard three-plane bone kernel reconstructions with a sensitivity of 90.7% and a specificity of 99.3% by transferring the knowledge of established MRI signs. The additional use of soft-tissue kernel reconstructions in three planes increased the sensitivity by 4.0% to 94.7%, specificity to 100%, inter-rater agreement to 1.0, and the diagnostic confidence of both readers improved to a median 4/5 (‘confident’) in both readers. (4) Conclusions: Trauma CT scan of the knee with three-plane soft-tissue reconstructions delivers the potential for the detection of dislocated bucket handle meniscal tears with very high diagnostic accuracy.
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Affiliation(s)
- Georg Gohla
- Department of Diagnostic and Interventional Neuroradiology, University-Hospital of Tuebingen, 72076 Tuebingen, Germany
- Department of Diagnostic and Interventional Radiology, University-Hospital of Tuebingen, 72076 Tuebingen, Germany
- Correspondence:
| | - Mareen Sarah Kraus
- Department of Diagnostic Radiology, IWK Health Care Centre, 5850 University Avenue, Halifax, NS B3K 6R8, Canada
| | - Isabell Peyker
- Department of Diagnostic and Interventional Radiology, University-Hospital of Tuebingen, 72076 Tuebingen, Germany
| | - Fabian Springer
- Department of Diagnostic and Interventional Radiology, University-Hospital of Tuebingen, 72076 Tuebingen, Germany
| | - Gabriel Keller
- Department of Diagnostic and Interventional Radiology, University-Hospital of Tuebingen, 72076 Tuebingen, Germany
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Sadighi M, Sabaghzadeh A, Biglari F, Ebrahimpour A, Karami A, Jafari Kafiabadi M. Clinical outcomes of Schatzker type II tibial plateau fractures using joint depression morphology: A cross-sectional study. Acta Orthop Belg 2023; 89:128-134. [PMID: 37294996 DOI: 10.52628/89.1.10846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Tibial plateau fracture is a common intra-articular fracture caused by axial compression and Varus or Valgus force. This study aimed at the relationship between Luo classification morphology of tibial plateau fractures with clinical outcomes and surgical complications. The cross-sectional study was conducted on patients with Schatzker type II tibial plateau fracture who underwent surgery between May 2018 and January 2021. Clinical outcomes were measured by the AKSS, VAS, Lysholm score, alignment, and ROM. A total of 65 patients with a mean age of 36.38 years were enrolled. There was a significant difference in AKSS (p=0.001), VAS score (p=0.011), and mechanical axis alignment (p=0.037) between the groups by pre-operative joint depression depth below and above 10 millimeters. The higher pre-operative or post- operative size of joint depression depth in patients with Schatzker type II tibial plateau fractures was associated with poor outcomes, more pain, and malalignment. A higher surface area of joint depression was associated with a lower clinical outcome score and more pain.
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Leblebicier MA, Yaman F, Saracoglu I, Ozkaya DB. The effects of tibial nerve mobilization in patients with tarsal tunnel syndrome: A randomized controlled trial. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2022.102201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Yao X, Hu M, Fu Y, Liu H, Pan X, Zhao J, Tang J. Proximal avulsion of five ligaments and revised diagonal principle in tibial plateau fractures. Injury 2022; 53:3494-3501. [PMID: 35853790 DOI: 10.1016/j.injury.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/08/2022] [Accepted: 07/10/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of the study was to analyze the incidence of proximal avulsion of the five main ligaments and to revise the diagonal tension/compression concept in tibial plateau fractures. METHODS Computed tomographic images of 1263 cases of tibial plateau fractures were retrospectively analyzed by the OTA/AO classification and four-column nine-segment classification. The correlation between proximal avulsion of five ligaments and the injury mechanism was analyzed. RESULTS In total, 1263 tibial plateau fractures in 1253 patients were included. A total of 92 cases (7.3%) associated with proximal avulsions were identified among the 1263 tibial plateau fracture cases obtained from our institution's database. The 92 avulsions occurred in 82 patients, among whom 10 patients had two different avulsions in a single knee. The incidence of proximal avulsion fracture of the medial and lateral collateral ligament was 3.6% (45/1263) and 2.1% (26/1263), respectively. The incidence of avulsion of the anterior cruciate ligament and avulsion of the posterior cruciate ligament was much lower at 0.2% (2/1263) and 0.1% (1/1263), respectively. Proximal avulsion of the patellar ligament occurred in 18 cases (incidence rate = 1.4%). Several combinations of injuries, composed of distal tibial plateau fractures and proximal avulsion of ligaments, were identified. CONCLUSIONS Among the patients with tibial plateau fracture, the incidence of proximal avulsion of the five ligaments was 7.3% (92/1263). The four-column and nine-segment classification is an exhaustive method for recording injuries in these ligaments. The revised diagonal injury concept is useful for understanding the injury mechanism and choosing the appropriate surgical strategy.
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Affiliation(s)
- Xiang Yao
- Department of Orthopaedics, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Minjie Hu
- Department of Orthopaedics, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, China; Jiangsu University, Zhenjiang, Jiangsu, China
| | - Yutong Fu
- Department of Acupuncture and Moxibustion Rehabilitation, Danyang Hospital of Traditional Chinese Medicine, Danyang, Jiangsu 212300, China
| | - Hongyuan Liu
- Department of Orthopaedics, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, China; Jiangsu University, Zhenjiang, Jiangsu, China
| | - Xiaohui Pan
- Department of Orthopaedics, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Jiajun Zhao
- Department of Orthopaedics, Nanjing Bond Department of Orthopedics Hospital, Nanjing, Jiangsu, China.
| | - Jilei Tang
- Department of Orthopaedics, Qidong Hospital of Traditional Chinese Medicine, Nantong, Jiangsu 226200, China.
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8
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Giordano V, Pires RE, Pimenta FS, Campos TVDO, Andrade MAPD, Giannoudis PV. Posterolateral Fractures of the Tibial Plateau Revisited: A Simplified Treatment Algorithm. J Knee Surg 2022; 35:959-970. [PMID: 33167054 DOI: 10.1055/s-0040-1721026] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
High-energy fractures of the proximal tibia with extensive fragmentation of the posterolateral (PL) quadrant of the tibial plateau are challenging to manage. Herein, we present a review of the literature on the patterns and options of approach and fixation of the PL fragment of the tibial plateau to optimize the treatment of this specific injury pattern. We searched PubMed (1980-May 2020) to identify and summarize the most relevant articles evaluating both the morphology and treatment recommendations, including the choice of approach and fixation strategy, for the PL tibial plateau fracture. We found PL fragment can present in several patterns as a pure split, split depression, contained pure depression, and noncontained depression (rim crush), which are mostly determined by the position of the knee and the force magnitude applied during the course of the accident. Based on previous concepts described by Schatzker and Kfuri, we suggest a simplified treatment algorithm highlighting the two concepts (buttressing and containment) used for plating the PL tibial plateau fragments. Based on the available current evidence, we propose an algorithm for these two morphological types of PL tibial plateau fracture. Shear-type fractures need buttressing (the "rule of thumb"), whereas noncontained peripheral rim-type fractures need peripheral repair and containment. Contained pure depression fractures are not frequent and need percutaneous-assisted elevation and subchondral rafting, either controlled by fluoroscopy or arthroscopically. It is believed that such an approach would simplify their assessment and preoperative planning and would assist the clinicians to appreciate and manage more consistently these complex injuries.
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Affiliation(s)
- Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, RJ, Brazil.,Clínica São Vicente, Rede D'or São Luiz, Rio de Janeiro, RJ, Brazil
| | - Robinson Esteves Pires
- Departamento de Ortopedia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | | | | | - Peter V Giannoudis
- Academic Department of Trauma & Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, United Kingdom
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Li L, Li Y, He Y, Deng X, Zhou P, Li J, Jiang H, Li Z, Liu J. Single-stage arthroscopic-assisted treatment of anteromedial tibial plateau fracture with posterolateral corner injury: a retrospective study. BMC Musculoskelet Disord 2022; 23:420. [PMID: 35513797 PMCID: PMC9069741 DOI: 10.1186/s12891-022-05387-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/28/2022] [Indexed: 02/08/2023] Open
Abstract
Background Anteromedial tibial plateau fracture with posterolateral corner (PLC) injury is a relatively rare combined injury in the clinic. In addition, there is no unified treatment scheme for this combined injury. The purpose of this study was to evaluate the clinical and imaging results of single-stage arthroscopic-assisted surgery for anteromedial tibial plateau fracture with PLC injury, and to explore the advantages of this surgical technique. Method In this retrospective study, a total of 9 patients (7 males and 2 females) were included, aged 24–64 years (average 40.7 years), treated in our Department of Orthopedics from January 2016 to January 2021. In the preoperative evaluations, there were 9 cases of anteromedial tibial plateau fractures with PLC injuries, 6 cases of concomitant PCL injuries, 6 cases of concomitant medial or lateral meniscus injuries, and 2 cases of concomitant fibular head avulsion fractures. All patients underwent single-stage arthroscopic-assisted surgery. Results All patients were followed up, and the average follow-up period was 15.2 months (range 12–18 months). The average operation time was 135.6 min (range 100–160 min), and the average surgical blood loss was 87.2 ml (range 60–110 ml). The anatomical reduction was achieved in 9 cases, and the anatomical reduction rate was 100%. The average fracture healing time was 13.1 weeks (range 12–16 weeks). At the last follow-up, the average VAS score was 1 (range 0–2); the average Lysholm function score was 90.7 (range 86–95), and the average IKDC score was 91.4 (range 88–95); the average knee extension angle of all patients was 0° and the average knee flexion angle was 128.3° (average 120–135°); The posterior drawer test, the Lachman test and the dial test were negative for all cases. None of the patients had operation-related complications. Conclusion Single-stage arthroscopy-assisted surgery in the treatment of anteromedial tibial plateau fracture with PLC injury can achieve good clinical outcomes, restore the stability of the knee joint, and reduce the risk of severe lower extremity dysfunction.
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Affiliation(s)
- Lingzhi Li
- Department of Orthopaedics, the Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, 646000, People's Republic of China
| | - Yuan Li
- Department of Orthopaedics, the Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, 646000, People's Republic of China
| | - Yanwei He
- Department of Orthopaedics, the Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, 646000, People's Republic of China
| | - Xiangtian Deng
- Orthopedic Research Institution, Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Peng Zhou
- Department of Orthopaedics, the Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, 646000, People's Republic of China
| | - Jun Li
- Department of Orthopaedics, the Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, 646000, People's Republic of China
| | - Hao Jiang
- Department of Orthopaedics, the Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, 646000, People's Republic of China
| | - Zhong Li
- Department of Orthopaedics, the Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, 646000, People's Republic of China.
| | - Juncai Liu
- Department of Orthopaedics, the Affiliated Hospital of Southwest Medical University, Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, 646000, People's Republic of China.
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10
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Magosch A, Jacquet C, Nührenbörger C, Mouton C, Seil R. Grade III pivot shift as an early sign of knee decompensation in chronic ACL-injured knees with bimeniscal tears. Knee Surg Sports Traumatol Arthrosc 2022; 30:1611-1619. [PMID: 34302192 DOI: 10.1007/s00167-021-06673-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/16/2021] [Indexed: 01/26/2023]
Abstract
PURPOSE To analyse possible associations between the preoperative pivot shift (PS) test and both patient and injury characteristics in anterior cruciate ligament (ACL)-injured knees, considering previously neglected meniscal injuries such as ramp and root tears. The hypothesis was that a preoperative grade III PS was associated with the amount of intra-articular soft-tissue damage and chronicity of the injury. METHODS The cohort involved 376 patients who underwent primary ACL reconstruction (239 males/137 females; median age 26). Patients were examined under anesthesia before surgery, using the PS test. During arthroscopy, intra-articular soft-tissue damage of the injured knee was classified as: (1) partial ACL tear; (2) complete isolated ACL tear; (3) complete ACL tear with one meniscus tear; and (4) complete ACL and bimeniscal tears. Chi-square and Mann-Whitney U tests were used to evaluate whether sex, age, body mass index, sport at injury, mechanism of injury, time from injury and intra-articular damage (structural damage of ACL and menisci) were associated with a grade III PS. Intra-articular damage was further analyzed for two sub-cohorts: acute (time from injury ≤ 6 months) and chronic injuries (> 6 months). RESULTS A grade III PS test was observed in 26% of patients. A significant association with PS grading was shown for age, time from injury and intra-articular soft-tissue damage (p < 0.05). Further analyses showed that grade III PS was associated with intra-articular damage in chronic injuries only (p < 0.01). In complete ACL and bimeniscal tears, grade III PS was more frequent in chronic (53%) than in acute knee injuries (26%; p < 0.01). Patients with chronic complete ACL and bimeniscal tears had a grade III PS 3.3 [1.3-8.2] times more often than patients in the acute sub-cohort. CONCLUSION In ACL-injured patients, a preoperative grade III PS was mainly associated with a higher amount of intra-articular soft-tissue damage and chronicity of the injury. Patients with complete chronic ACL injuries and bimeniscal tears were more likely to have a preoperative grade III PS than their acute counterparts. This suggests that grade III PS may be an early sign of knee decompensation of dynamic rotational knee laxity in chronic ACL-injured knees with bimeniscal lesions. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Amanda Magosch
- Sports Clinic, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78 Rue d'Eich, 1460, Luxembourg, Luxembourg
| | - Christophe Jacquet
- Institute for Movement and Locomotion (IML), Department of Orthopedic Surgery and Traumatology, St. Marguerite Hospital, Marseille, France
| | - Christian Nührenbörger
- Sports Clinic, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78 Rue d'Eich, 1460, Luxembourg, Luxembourg.,Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg
| | - Caroline Mouton
- Sports Clinic, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78 Rue d'Eich, 1460, Luxembourg, Luxembourg.,Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg
| | - Romain Seil
- Sports Clinic, Centre Hospitalier de Luxembourg-Clinique d'Eich, 78 Rue d'Eich, 1460, Luxembourg, Luxembourg. .,Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg. .,Human Motion, Orthopaedics, Sports Medicine and Digital Methods, Luxembourg Institute of Health, Strassen, Luxembourg.
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11
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Krause M, Frosch KH. [Change in the treatment of tibial plateau fractures]. Unfallchirurg 2022; 125:527-534. [PMID: 35380266 DOI: 10.1007/s00113-022-01165-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The treatment of tibial plateau fractures has experienced a number of very different conceptual developments in recent years, not only with respect to technical innovations but also against the background of changing fracture patterns and the growing requirements of patients. OBJECTIVE What developments in recent years have had a significant impact on current treatment strategies for tibial plateau fractures? METHODS Narrative review of publications listed in PubMed on the topic of treatment of complex tibial plateau fractures. RESULTS While the two-dimensional classifications are becoming less important, computed tomography (CT)-based three-dimensional assessment of fracture progression and an access strategy based on it are coming to the fore. Direct dorsal approaches have been shown to be superior, particularly in the case of relevant posteromedial and/or posterolateral fracture involvement. The step-by-step approach extension via specific osteotomies of ligamentous attachments also enables a needs-dependent and fracture-dependent complete joint visualization and reduction control. In the treatment of geriatric tibial plateau fractures, primary treatment with endoprostheses is becoming increasingly more important to enable early mobilization under full load bearing with significantly shorter rehabilitation times. CONCLUSION Modern developments in the context of fracture treatment around the tibial plateau have led to a relevant reduction of infections and improved surgical outcomes; however, the high demands and the improved understanding of fractures still underline the great challenge in the treatment of complex fracture patterns.
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Affiliation(s)
- Matthias Krause
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Karl-Heinz Frosch
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.,Abteilung für Unfallchirurgie, Orthopädie und Sporttraumatologie, BG Klinikum Hamburg, Hamburg, Deutschland
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Tuncez M, Akan I, Seyfettinoğlu F, Çetin Tunçez H, Dirim Mete B, Kazımoğlu C. Is It Necessary To Add Soft Tissue Injury to the Classification in Tibial Plateau Fracture Management? Cureus 2022; 14:e22236. [PMID: 35340472 PMCID: PMC8929476 DOI: 10.7759/cureus.22236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 11/22/2022] Open
Abstract
Background A gold standard classification for the treatment of tibial plateau fractures with soft tissue injury has not been established yet.This study aimed to evaluate the usability of a novel modified classification that can provide preoperative information to the surgeon about soft tissue injuries in tibial plateau fractures. Methodology A total of 36 patients with tibial plateau fractures were included in the study. Patients’ age, gender, and affected sides were recorded. Injuries to the medial meniscus, lateral meniscus, anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, and lateral collateral ligament were examined with preoperative magnetic resonance imaging. Soft tissue injuries were arranged according to the novel modified classification based on the Schatzker classification. Results The mean age of the study participants was 45 (19-76) years; 72% of the patients were men and 28% were women. Moreover, 44% and 56% of the patients had broken the right and left tibial plateaus, respectively. At least one soft tissue injury was detected in 29 (81%) patients. In 14 (39%) patients, two or more soft tissue injuries were observed. All patients were arranged according to the novel modified classification regarding ligament and meniscus injuries. Conclusions With this novel modified classification system, we think that having better information about the preoperative condition of the soft tissue injuries can change the surgical strategy in patients with tibial plateau fractures.
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Clinical Application Study of Minimally Invasive Double-Reverse Traction in Complex Tibial Plateau Fractures. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5564604. [PMID: 35103238 PMCID: PMC8800596 DOI: 10.1155/2022/5564604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 08/21/2021] [Accepted: 12/06/2021] [Indexed: 11/21/2022]
Abstract
The aim of this study was to evaluate the clinical application of double-reverse traction for minimally invasive reduction of complex tibial plateau fractures. A retrospective analysis was performed to identify all patients admitted to the Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, from March 2017 to December 2019 with Schatzker type VI tibial plateau fractures. 12 patients were identified (7 men and 5 women) with an average age of 46.15 ± 13 (39-58) years old. All patients were treated with double-reverse traction and closed reduction. After the fracture was reduced, the bone plate was fixed by percutaneous minimally invasive implantation. Outcomes assessed in this study include operation time and intraoperative blood loss. Imaging was performed during the postoperative follow-up, and functional recovery was evaluated at the final follow-up according to the Hospital for Special Surgery (HSS) score and the International Knee Joint Literature Committee (IKDC) functional score. Patients were followed up for 12.54 ± 1.5 (8-15) months. The average operation time was 63.63 ± 21 (35-120) minutes, and the average intraoperative blood loss was 105.45 ± 21 (60-200) mL. The Rasmussen imaging score was either excellent or good in all cases. The knee joint HSS score was 86.15 ± 6 (79-90) points, and the IKDC score was 80.01 ± 11 (75-90) points. No complications, such as wound infection, incision disunion, loosening of internal fixation, and internal fixation failure, occurred. In the treatment of Schatzker VI type complex tibial plateau fracture, the dual-reverse traction minimally invasive technique has the advantages of safety and effectiveness, less soft tissue injury, and allowing early joint movement, which is worthy of clinical promotion.
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Pu Y, Lei Z, Wenge D, Yue X, Xiaowei J, Kejie W, Yiwen Z, Zhihui H, Xiaoyu D. Correlation between CT images of lateral plateau and lateral meniscus injuries in patients with Schatzker II tibial plateau fractures:a retrospective study. BMC Musculoskelet Disord 2022; 23:9. [PMID: 34980066 PMCID: PMC8725471 DOI: 10.1186/s12891-021-04967-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 12/13/2021] [Indexed: 11/28/2022] Open
Abstract
Background There is a great deal of controversy on whether routine MRI examination is needed for fresh fractures while the vast majority of patients with tibial plateau fractures (TPFs) receive preoperative X-ray and CT examinations. The purpose of the study was to analyze the exact correlation between CT images of lateral plateau and lateral meniscus injuries in Schatzker II TPFs. Methods A total of 296 patients with Schatzker II TPFs from August 2012 to January 2021 in two trauma centers were enrolled for the analysis. According to the actual situation during open reduction internal fixation (ORIF) and knee arthroscopic surgery, patients were divided into meniscus injury (including rupture, incarceration, etc.) and non-meniscus injury groups. The values of both lateral plateau depression (LPD) and lateral plateau widening (LPW) of lateral tibial plateau on CT images were measured, and their correlation with lateral meniscus injury was then analyzed. The relevant receiver operating characteristic (ROC) curve was drawn to evaluate the optimal cut-off point of the two indicators which could predict meniscus injury. Results The intra- and inter-observer reliabilities of LPD and LPW were acceptable (intraclass correlation coefficient (ICC) > 0.8). The average LPD was 13.2 ± 3.2 mm while the average value of the group without meniscus injury was 9.4 ± 3.2 mm. The difference between the two groups was statistically significant (P < 0.05). The average LPW was 8.0 ± 1.4 mm and 6.8 ± 1.6 mm in meniscus injury and non-meniscus injury groups with a significant difference (P < 0.05). The optimal predictive cut-off value of LPD and LPW was 7.9 mm (sensitivity-95.0%, specificity-58.8%, area under the curve (AUC-0.818) and 7.5 mm (sensitivity-70.0%, specificity - 70.6%, AUC - 0.724), respectively. The meniscus injury group mainly showed injuries involving the mid-body and posterior horn of lateral meniscus (98.1%, 157/160). Conclusions The mid-body and posterior horn of lateral meniscus injury is more likely to occur in patients with Schatzker II TPFs when LPD > 7.9 mm and/or LPW > 7.5 mm on CT. These findings will definitely provide guidance for orthopedic surgeons in treating such injuries. During the operation, more attention is required be paid to the treatment of the meniscus and the possible fracture reduction difficulties and poor alignment caused by meniscus rupture and incarceration should be fully considered in order to achieve better surgical results.
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Affiliation(s)
- Ying Pu
- Department of Orthopedics, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, 6 Huanghe Road, Changshu, Jiangsu Province, 215500, China
| | - Zhu Lei
- Department of Orthopedics, The Third Affiliated Hospital of Soochow University, 185 Juqian Road, Changzhou, Jiangsu Province, 213000, China
| | - Ding Wenge
- Department of Orthopedics, The Third Affiliated Hospital of Soochow University, 185 Juqian Road, Changzhou, Jiangsu Province, 213000, China
| | - Xu Yue
- Department of Orthopedics, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, 6 Huanghe Road, Changshu, Jiangsu Province, 215500, China
| | - Jiang Xiaowei
- Department of Orthopedics, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, 6 Huanghe Road, Changshu, Jiangsu Province, 215500, China
| | - Wang Kejie
- Department of Orthopedics, The Third Affiliated Hospital of Soochow University, 185 Juqian Road, Changzhou, Jiangsu Province, 213000, China
| | - Zhao Yiwen
- Department of Orthopedics, The Third Affiliated Hospital of Soochow University, 185 Juqian Road, Changzhou, Jiangsu Province, 213000, China
| | - Huang Zhihui
- Department of Orthopedics, The Third Affiliated Hospital of Soochow University, 185 Juqian Road, Changzhou, Jiangsu Province, 213000, China
| | - Dai Xiaoyu
- Department of Orthopedics, The Third Affiliated Hospital of Soochow University, 185 Juqian Road, Changzhou, Jiangsu Province, 213000, China.
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15
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Ho W, Chih WH, Yeh ML, Lin SF, Su WR, Chiang CH. "Flip lid" type of lateral tibia plateau fracture with a meniscus radial tear: A case report. Trauma Case Rep 2021; 34:100496. [PMID: 34195339 PMCID: PMC8220546 DOI: 10.1016/j.tcr.2021.100496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/26/2022] Open
Abstract
Case A 45-year-old woman sustained a unique lateral tibia plateau fracture pattern with a vertically rotated fragment composed of an intact articular surface and subchondral bone. During open reduction and internal fixation (ORIF), a full thickness radial tear of the lateral meniscus was found, which was repaired under direct visualization through arthrotomy. At final follow-up, the patient regained pain-free activity with good meniscus healing, as confirmed with a second-look arthroscopic examination. Conclusion This case represents an undescribed fracture pattern that indicates an associated meniscus injury. A thorough evaluation, including Magnetic Resonance Imaging should be considered. One-stage ORIF followed with meniscus repair represents a good treatment option.
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Affiliation(s)
- Wei Ho
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Wei-Hsing Chih
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Ming-Long Yeh
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Shu-Fan Lin
- Department of Orthopaedic Surgery, Ministry of Health and Welfare Cishan Hospital, Kaohsiung, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chen-Hao Chiang
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.,Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
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16
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The degree of fracture displacement does not affect the risk for concomitant proximal fibular fractures in tibial plateau fractures. INTERNATIONAL ORTHOPAEDICS 2021; 45:2963-2971. [PMID: 33825001 DOI: 10.1007/s00264-021-05034-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The proximal fibula plays an important role in the knee joint; however, it has not been given enough attention by surgeons. This study aimed to investigate the risk factors for concomitant proximal fibular fractures in patients with tibial plateau fractures through computed tomography (CT) imaging. MATERIALS AND METHODS From January 2016 to November 2017, patients who underwent percutaneous reduction and internal fixation (PRIF) for tibial plateau fractures at a level 1 trauma centre institute were included in this retrospective study. Full materials of CT imaging were obtained for measurements. Schatzker's and a newly proposed classification system were used for the fracture of the tibial plateau and proximal fibula, respectively. Several clinical and radiological characteristics were recorded, and the impact of those variables on fibular fractures was assessed with univariate and multivariate analyses. RESULTS In total, 174 patients were enrolled in the study with mean age of 45.6±13.1 years. The incidence of combined proximal fibular fracture was 38.3%. Schatzker type VI fracture had the highest rate of fibular fracture (77.4%). High-energy-pattern tibial plateau fractures (p=0.029) and posterolateral joint facet (PJF) involvements (p=0.002) are risk factors for proximal fibular fracture on multivariate analysis. Neither posterolateral column (PLC) involvements nor fracture displacement correlated with proximal fibular fractures. CONCLUSIONS Proximal fibular fractures were commonly seen among patients who sustained tibial plateau fractures. Schatzker type VI fractures had the highest rate of fibular fractures than other fracture types. High-energy fractures and PJF involvements correlated with a higher risk of proximal fibular fractures. A better understanding and awareness of the risk factors for proximal fibular fractures will provide surgeons with comprehensive understanding of tibial plateau fractures.
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Deng X, Hu H, Wang Y, Shao D, Zhang Y. Arthroscopically assisted evaluation of frequency and patterns of meniscal tears in operative tibial plateau fractures: a retrospective study. J Orthop Surg Res 2021; 16:117. [PMID: 33549145 PMCID: PMC7868009 DOI: 10.1186/s13018-021-02265-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/26/2021] [Indexed: 11/18/2022] Open
Abstract
Background Despite tibial plateau fractures are often associated with meniscal tears, the association between meniscal tears and Schatzker classification remains unclear. The purpose of this study was to assess the frequency and patterns of meniscal tears in operatively treated tibial plateau fractures following immediate arthroscopic evaluation after internal fixation of tibial plateau fractures and to reveal the association between these concomitant meniscal tears and Schatzker classification. Methods A total of 252 consecutive patients (166 males and 86 females, mean age 46.7 (19–80) years) with operatively treated tibial plateau fractures admitted to our hospital from January 2016 to May 2019 were performed. Arthroscopic examination for frequency and patterns of meniscal tears was evaluated and documented at the time of surgery, and the association between the frequency and patterns of meniscal tears with Schatzker classification was then analyzed. Results The overall frequency of meniscal tears in TPFs was 67% (168 of 252) with 33% (84 of 252) of these being lateral meniscal tears, and 10% (26 of 252) medial meniscal tears, while 23% (58 of 252) had bilateral meniscal tears. Schatzker II was most commonly associated with meniscal tears, occurring in 72% (71 of 99) of our series. There is no significant difference between the frequency of meniscal tears and Schatzker classification (p > 0.05). The most common patterns of meniscal tears were longitudinal tears in 23% of tibial plateau fractures (59 of 252), and it occurred at a significantly higher frequency in Schatzker II with 43% (43 of 99). Schatzker IV had significantly higher prevalence of bucket-handle tears than other fracture patterns (p < 0.05), and Schatzker VI fractures had significantly higher prevalence of complex tears than other fracture patterns (p < 0.05). For other Schatzker classification, the patterns of meniscal tears demonstrated no statistical difference (p > 0.05). Conclusion The results identified that meniscal tears are commonly seen in each Schatzker classification. Although various patterns of meniscal tears occurred in tibial plateau fractures, the most common patterns were longitudinal tears. Importantly, we suggest that the status of meniscal tears associated with TPFs should be considered at the time of surgery in addition to fracture fixation.
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Affiliation(s)
- Xiangtian Deng
- School of Medicine, Nankai University, Tianjin, 300071, People's Republic of China
| | - Hongzhi Hu
- Department of Orthopedics, The Union Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yuchuan Wang
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, 430022, China
| | - Decheng Shao
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, 430022, China
| | - Yingze Zhang
- School of Medicine, Nankai University, Tianjin, 300071, People's Republic of China. .,Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, 430022, China.
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Chen YD, Chen SX, Liu HG, Zhao XS, Ou WH, Li HX, Huang HX. Is traumatic meniscal lesion associated with acute fracture morphology changes of tibia plateau? A series of arthroscopic analysis of 67 patients. World J Clin Cases 2021; 9:81-90. [PMID: 33511174 PMCID: PMC7809655 DOI: 10.12998/wjcc.v9.i1.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/10/2020] [Accepted: 11/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Computed tomography (CT) has become a routine preoperative examination for tibial plateau fractures (TPFs). Assessing the location of the fragment and intercondylar eminence fracture can provide clinicians with valuable information; however, the evaluation of traumatic meniscal lesion (TML) and arthroscopic management are controversial.
AIM To predict TML by three-dimensional skeletal anatomy changes in unilateral TPF and bilateral TPF on preoperative thin layer CT.
METHODS Acute fracture of tibial plateau patients undergoing arthroscopic surgery between December 2017 and December 2019 were included in this retrospective study. The type, zone, and location of TMLs were diagnosed based on the operation records and/or arthroscopic videos. Measurement of three-dimensional fracture morphology included the following: Frontal fragment width of plateau, sagittal fragment subsiding distance (FSD), sagittal fracture line distance, sagittal posterior tibial slope, and transversal area ratio of fragment area) on preoperative CT three-dimensional plane. The correlation of TML with skeletal values was calculated according to unicondylar TPFs and bicondylar TPFs.
RESULTS A total of 67 patients were enrolled in this study, among which 30 patients had TMLs, lateral/medial (23/7). FSD was a particularly positive factor to predict TML, with odds ratio of 2.31 (1.26-5.63). On sagittal view of CT, FSD degree of 8 mm and posterior tibial slope exceeding 11.74° implied enhanced risk of TML in bicondylar TPFs. On coronal view, once fragment width of plateau surpassed 3 cm, incidence of TML reached 100%. On transverse view, area ratio of fragment as enhanced risk of 5.5% and FSD > 4.3 mm for predicting TML were observed in unicondylar TPFs.
CONCLUSION TML can be predicted by different parameters on preoperative CT views according to unicondylar fractures and bicondylar TPFs.
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Affiliation(s)
- Yan-Dong Chen
- 3rd Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
- Department of Joint Trauma, Jiangmen Wuyi Hospital of Traditional Chinese Medicine, Affiliated Jiangmen Traditional Chinese Medicine Hospital of Jinan University, Jiangmen 529031, Guangdong Province, China
| | - Shu-Xiang Chen
- Department of Joint Trauma, Jiangmen Wuyi Hospital of Traditional Chinese Medicine, Affiliated Jiangmen Traditional Chinese Medicine Hospital of Jinan University, Jiangmen 529031, Guangdong Province, China
| | - Hong-Guang Liu
- Department of Joint Trauma, Jiangmen Wuyi Hospital of Traditional Chinese Medicine, Affiliated Jiangmen Traditional Chinese Medicine Hospital of Jinan University, Jiangmen 529031, Guangdong Province, China
| | - Xiang-Sheng Zhao
- Department of Radiology, Jiangmen Wuyi Hospital of Traditional Chinese Medicine, Jiangmen 529031, Guangdong Province, China
| | - Wen-Huan Ou
- Department of Joint Trauma, Jiangmen Wuyi Hospital of Traditional Chinese Medicine, Affiliated Jiangmen Traditional Chinese Medicine Hospital of Jinan University, Jiangmen 529031, Guangdong Province, China
| | - Huan-Xi Li
- Department of Joint Trauma, Jiangmen Wuyi Hospital of Traditional Chinese Medicine, Affiliated Jiangmen Traditional Chinese Medicine Hospital of Jinan University, Jiangmen 529031, Guangdong Province, China
| | - Hong-Xing Huang
- Science and Education Section, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510378, Guangdong Province, China
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Van den Berg JD, Quintens L, Zhan Y, Hoekstra H. Why address posterior tibial plateau fractures? Injury 2020; 51:2779-2785. [PMID: 32958346 DOI: 10.1016/j.injury.2020.09.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/15/2020] [Indexed: 02/02/2023]
Abstract
Management of posterior tibial plateau fractures has gained much interest over the past few years. Fracture morphology, trauma mechanism, and soft-tissue injury have been identified as the key factors determining the treatment strategy and outcome. We provide a rationale for the operative management of posterior tibial plateau fractures by discussing the interplay between fracture morphology, trauma mechanism, and soft-tissue injury. The trauma mechanism has proven to be an important tool, not only to understand fracture morphology, but also to assess concomitant soft-tissue (i.e. ligamentous) injury. Subsequently, soft-tissue injury might play a role in future classification and diagnostic work-up of tibial plateau fractures, particularly in fractures with posterior involvement. Plate osteosynthesis using a posterior approach is safe and should be considered routinely in coronal fractures of the posterior tibial plateau, as illustrated.
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Affiliation(s)
- J D Van den Berg
- University Hospitals Leuven, Department of Trauma Surgery, B-3000 Leuven, Belgium
| | - L Quintens
- University Hospitals Leuven, Department of Trauma Surgery, B-3000 Leuven, Belgium
| | - Y Zhan
- Department of Orthopaedic Surgery, Shanghai Jiaotong University, affiliated Shanghai 6th People's Hospital, Shanghai, China
| | - H Hoekstra
- University Hospitals Leuven, Department of Trauma Surgery, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, Department of Development and Regeneration, B-3000 Leuven, Belgium.
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20
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Rudran B, Little C, Wiik A, Logishetty K. Tibial Plateau Fracture: Anatomy, Diagnosis and Management. Br J Hosp Med (Lond) 2020; 81:1-9. [PMID: 33135915 DOI: 10.12968/hmed.2020.0339] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Tibial plateau fractures are peri-articular knee fractures of the proximal tibia. The presentation is dependent on the mechanism of injury. The tibial plateau is the bony platform of the distal half of the knee joint, and is made up of a medial and lateral condyle separated by the intercondylar eminence. The presentation of tibial plateau fractures can vary greatly as a result of the bimodal mechanism of injury and patient characteristics. The patient should be assessed for life- and limb-threatening injuries in accordance with British Orthopaedic Association Standards of Trauma guidelines. Imaging is undertaken to understand configuration of the fracture, which is classified by the Schatzker classification. Definitive management of the fracture depends on the severity, ranging from conservative to surgical management. Surgery is required for more severe tibial plateau fractures to restore articular congruity, mechanical alignment, ligamentous stability and to permit early mobilisation. Medium-term functional outcome after tibial plateau fractures is generally excellent when anatomy and stability is restored. At least half of patients return to their original level of physical activity. Surgical management of tibial plateau fractures is not without complication. Risk factors include postoperative arthritis, bicondylar and comminuted fractures, meniscal removal, instability, malalignment and articular incongruity. Tibial plateau fractures account for 1% of all fractures, and typically occur either as a fragility fracture or secondary to a high-energy impact. These latter injuries are associated with extensive soft tissue injury, life- and limb-threatening complications and long-term sequelae. While outcomes are generally good, severe injuries are at higher risk of infection and post-traumatic arthritis requiring knee arthroplasty. This article considers the anatomy, diagnosis and evidence-based management strategies for tibial plateau fracture.
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Affiliation(s)
| | - Christopher Little
- School of Medicine, Imperial College London, London, UK Conflicts of interest
| | - Anatole Wiik
- The MSk Lab, Imperial College London, London, UK
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Adams JDJ, Loeffler MF. Soft Tissue Injury Considerations in the Treatment of Tibial Plateau Fractures. Orthop Clin North Am 2020; 51:471-479. [PMID: 32950216 DOI: 10.1016/j.ocl.2020.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Tibial plateau fractures represent a highly variable spectrum of injury that requires a multifaceted diagnostic and therapeutic approach in order to adequately treat. Constant vigilance is required to consider all the injured structures and avoid focusing only on the bony aspect of the injury. Management of the soft tissue envelope and repair/reconstruction of critical stabilizing structures of the knee should be at the forefront of the thought process when approaching these complex injuries. This article aims to emphasize the high incidence of injury to associated soft tissue structures and provide general approach considerations to these complex injuries.
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Affiliation(s)
- John D Jd Adams
- Department of Orthopedic Surgery, Division of Orthopedic Trauma, Prisma Health, Greenville Memorial Medical Hospital, 701 Grove Road, 2nd Floor Support Tower, Greenville, SC 29605, USA.
| | - Markus F Loeffler
- Department of Orthopedic Surgery, Prisma Health, Greenville Memorial Medical Hospital, 701 Grove Road, 2nd Floor Support Tower, Greenville, SC 29605, USA
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22
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Gorbachova T, Melenevsky YV. Trauma About the Knee. Semin Roentgenol 2020; 56:22-38. [PMID: 33422180 DOI: 10.1053/j.ro.2020.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tetyana Gorbachova
- Radiology Jefferson Medical College, Department of Radiology, Einstein Medical Center, Philadelphia, PA.
| | - Yulia V Melenevsky
- University of Alabama at Birmingham, Department of Radiology, UAB Medical Center, Birmingham, AL
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Davis JT, Rudloff MI. Posttraumatic Arthritis After Intra-Articular Distal Femur and Proximal Tibia Fractures. Orthop Clin North Am 2019; 50:445-459. [PMID: 31466661 DOI: 10.1016/j.ocl.2019.06.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Posttraumatic arthritis (PTA) is a form of joint degeneration that occurs after physical trauma to a synovial joint. Development of PTA is multifactorial and results from mechanical damage at the time of trauma, a cell-mediated inflammatory response, and abnormal articulation due to persistent malalignment or joint instability. Although some risk factors may be unavoidable, preventing the development of PTA of the knee after intra-articular fracture (IAF) requires restoring anatomic articulation and alignment. Reconstruction with total knee arthroplasty is the treatment of choice for PTA and may be a useful primary treatment for IAF in some.
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Affiliation(s)
- Jacob T Davis
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, 1211 Union Avenue, Suite 520, Memphis, TN 38104, USA; Regional One Health Medical Center, 877 Jefferson Avenue, Memphis, TN 38103, USA; The Campbell Foundation, 1211 Union Avenue, Suite 500, Memphis, TN 38104, USA.
| | - Matthew I Rudloff
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, 1211 Union Avenue, Suite 520, Memphis, TN 38104, USA; Regional One Health Medical Center, 877 Jefferson Avenue, Memphis, TN 38103, USA; The Campbell Foundation, 1211 Union Avenue, Suite 500, Memphis, TN 38104, USA
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