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Patel SK, Khan S, Lohiya A, Goyal S. Innovative Approach to Lateral Tibial Plateau Fracture: A Case Study on Anterolateral Submeniscal Arthrotomy With Cement Augmentation and Screw Fixation. Cureus 2024; 16:e55416. [PMID: 38567216 PMCID: PMC10985421 DOI: 10.7759/cureus.55416] [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: 12/01/2023] [Accepted: 03/02/2024] [Indexed: 04/04/2024] Open
Abstract
Lateral tibial plateau fractures are generally present as depressed fractures. The lateral tibial plateau is more common than the medial tibial plateau, often due to a bumper injury. If depressed fragments are more than 8-10 mm, then surgical management is usually needed. Anterolateral fixation is frequently used for unicondylar lateral tibial plateau fractures. Here, we present an articular depressed lateral tibia plateau fracture in a Schatzker type 3 case. The fracture was managed through an anterolateral approach with sub-meniscal arthrotomy, allowing for direct visualization and subsequent fixation using bone cement and a cannulated cancellous screw. Postoperative imaging confirmed proper reduction, and the patient had a satisfactory outcome..
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Affiliation(s)
- Siddharth K Patel
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sohael Khan
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ashutosh Lohiya
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Saksham Goyal
- Department of Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Kabra A, Mittal S, Mukherjee K, Kumar A, Chowdhury B, Trikha V. 3D mapping: has the mystery of proximal tibia fractures been solved? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3001-3010. [PMID: 36934361 DOI: 10.1007/s00590-023-03520-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/06/2023] [Indexed: 03/20/2023]
Abstract
PURPOSE One of the major limitations of the 2D fracture evaluation (Schatzker classification) is its failure to adequately assess fracture lines in the frontal plane and fracture displacement in the antero-posterior direction. 3D fracture line mapping includes steric assessment which can aid decision making with regards to the surgical approach and fixation scheme. We hypothesized that there are consistent fracture patterns and zones of comminution for proximal tibial fractures. METHODS Radiographic data of 228 proximal tibia fractures were retrospectively included in this study. Fracture lines and zones of comminution were graphically superimposed onto a 3D template of an intact tibia after virtual reduction and normalization to identify major patterns of fracture and comminution. RESULTS Out of 206 male and 21 female patients, 89 had a fracture of the lateral condyle only (Schatzker I and II), 53 involved the medial plateau only (Schatzker IV) and 86 had a high-grade fracture involving both the condyles (Schatzker V and VI). 64.5% of the fracture lines involving the medial plateau alone were in the coronal plane, and this number was even lesser (44.2%) in medial plateau involvement of bicondylar fractures. In bicondylar fractures, lines were usually not seen to pass directly through the posteromedial region. CONCLUSIONS Medial tibial plateau fractures have a mix of coronal or sagittal fracture alignment. A clearer understanding of the 3D orientations of fractures based on CT scans can aid in diagnosing the pattern of fracture and adequate positioning of plates can be done to eventually improve operative outcomes.
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Affiliation(s)
- Apoorva Kabra
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Samarth Mittal
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Kaushik Mukherjee
- Department of Mechanical Engineering, Indian Institute of Technology, New Delhi, 110016, India
| | - Atin Kumar
- Department of Radiology/Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Buddhadev Chowdhury
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Vivek Trikha
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, 110029, India.
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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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Yao X, Hu M, Liu H, Tang J, Yuan J, Zhou K. Classification and morphology of hyperextension tibial plateau fracture. INTERNATIONAL ORTHOPAEDICS 2022; 46:2373-2383. [PMID: 35831750 DOI: 10.1007/s00264-022-05499-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/22/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE This study was aimed at analyzing the incidence and characteristics of hyperextension tibial plateau fractures (HTPFs) by using a computed tomography (CT)-based "four-column and nine-segment" classification. METHODS In the coronal plane, HTPFs are divided into four types: pure hyperextension, hyperextension-varus, hyperextension-valgus, and hyperextension-bicondylar. Fractures in the sagittal plane were divided into three types: type 1, pure depression; type 2, cleavage extending to the posterior cortex with no displacement; and type 3, cleavage extending to the posterior cortex with a significant displacement. A retrospective analysis of CT images of the tibial plateau fractures from December 2007 to December 2021 was conducted. Fracture mapping was analyzed and drawn using the new classification system. RESULTS A total of 136 (10.9%, 136/1253) fractures fulfilled the radiographic criteria for HTPF pattern in 136 knees (53.5 ± 13.3 years). There were 11 knees with pure hyperextension fracture (8.1%), 23 with hyperextension-varus fracture (16.9%), 46 with hyperextension-valgus fracture (33.8%), and 56 with hyperextension-bicondylar fracture (41.2%) in the coronal plane. Furthermore, there were 64 (47.1%), 47 (34.6%), and 25 (18.4%) cases of type 1, type 2, and type 3 fractures, respectively, in the sagittal plane. In the three-dimensional heat map, the fracture lines were mainly located at the anterior rim of the tibial plateau, while the posterior articular surface was rarely involved. CONCLUSIONS The main manifestations of HTPF are anterior compression and posterior avulsion injury. The CT-based four-column and nine-segment classification system could be used to categorize the injury characteristics of HTPF in the coronal and sagittal planes.
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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
| | - Hongyuan Liu
- Department of Orthopaedics, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
- Jiangsu University, Zhenjiang, Jiangsu, China
| | - Jilei Tang
- Department of Orthopaedics, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Jishan Yuan
- Department of Orthopaedics, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, Jiangsu, China.
| | - Kaihua Zhou
- Department of Orthopaedics, Qidong Hospital of Traditional Chinese Medicine, Nantong, Jiangsu, China, 226200.
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Wu LP, Mayr HO, Cai Q, Huan YQ, Zhu XH, Chen YZ, Tang YP, Huang XY. A New Three-Dimensional Classification of Proximal Tibiofibular Fractures: A Multicenter Study. Orthop Surg 2021; 13:2442-2456. [PMID: 34672099 PMCID: PMC8654672 DOI: 10.1111/os.13161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives To propose an updated definition of proximal tibia and fibula fracture (PTFF) and establish a three‐dimensional (3D) structure‐based classification of PTFF. Methods In total, 1358 adult patients (837 males and 521 females; 43.61 ± 15.13 years, 1364 affected knees) who were diagnosed with PTFF at the departments of orthopaedic surgery of four hospitals from January 2010 to December 2019 were enrolled. The new classification of PTFF, termed Wu classification, included three parts: classification of columns in the horizontal plane, regions in the frontal plane, and segments in the sagittal plane. All PTFFs were classified according to Schatzker, Luo, and Wu classification systems. Additionally, the incidence and characteristics of PTFFs were analyzed. Results The major internal structural fractures of PTFF were tibial plateau fracture (TPF) only (725, 53.15%), TPF and proximal fibular fracture (274, 20.09%), and isolated avulsion fracture of the posterior cruciate ligament (PCL) (189, 13.86%). Approximately a quarter of PTFF cases could not be classified using Schatzker or Luo classifications, but all PTFF cases could be classified using Wu classification. The most frequent PTFFs included all four columns in region IV, segment 2 (235, 17.23%); the posterolateral and posteromedial columns in region II, segment 2 (191, 14.00%); and the lateral and posterolateral columns in region IV, segment 2 (136, 9.97%). Isolated avulsion fracture of the anterior cruciate ligament (ACL) was categorized as three injury types, most of which involved the lateral and medial columns in region II, segment 1 (40/63, 64%). More than 97% of cases of isolated fractures of the PCL involved the posterolateral and posteromedial columns in region II, segment 2. The most frequent combined avulsion fracture of the ACL and PCL included all four columns in region II, segment 2 (18/24, 75%). All of the isolated avulsion fractures of the ACL were located in segment 1, and all those of the PCL in segment 2. The most common type of isolated proximal fibular fracture involved the posterolateral column in region III, segment 2 (23/26, 88%). The most frequent combined TPF and proximal fibular fracture involved all four columns in region IV, segment 2 (107/274, 39.05%). Conclusions All cases of PTFF could be classified by the new 3D Wu classification which should be beneficial for clinical diagnosis, guidance of treatment, statistical analysis, academic communication, and prognosis, and the most frequent PTFF involved all four columns in region IV, segment 2.
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Affiliation(s)
- Li-Ping Wu
- Department of Joint and Trauma Surgery, Jiangmen Central Hospital (Affiliated Jiangmen Hospital of Sun Yat-Sen University), Jiangmen, China
| | - Hermann O Mayr
- Department of Orthopaedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Qin Cai
- Department of Orthopaedic Surgery, Jiangmen Wuyi Hospital of Traditional Chinese Medicine (TCM), (Affiliated Jiangmen TCM Hospital of JiNan University), Jiangmen, China
| | - Yuan-Qiao Huan
- Department of Joint and Trauma Surgery, Jiangmen Central Hospital (Affiliated Jiangmen Hospital of Sun Yat-Sen University), Jiangmen, China
| | - Xiao-Hua Zhu
- Department of Orthopaedic Surgery, Zhongshang Xiaolang people's Hospital (Affiliated Xiaolang Hospital of Southern Medical University), Zhongshang, China
| | - Yuan-Zhuang Chen
- Department of Joint and Trauma Surgery, Jiangmen Central Hospital (Affiliated Jiangmen Hospital of Sun Yat-Sen University), Jiangmen, China
| | - Yi-Ping Tang
- School of Foreign Languages, Southern Medical University, Guangzhou, China
| | - Xin-Yu Huang
- Department of Trauma Surgery, Jiangmen people's Hospital, (Affiliated Jiangmen Hospital of Southern Medical University), Jiangmen, China
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Erdman MK, Gibbs SJ, Tucker DW, Lee AK, Fleming ME, Marecek GS. Radiographic detection of lateral plateau involvement in medial tibial plateau fractures (AO/OTA 41-B1.2, 1.3, 3.2 and 3.3). EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1501-1508. [PMID: 34557963 DOI: 10.1007/s00590-021-03117-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the accuracy of radiographs in detecting the lateral plateau involvement of medial tibial plateau fractures as well as describe the impact of CT on preoperative planning for this specific fracture morphology. METHODS Radiograph and CT imaging of patients with a Schatzker type IV tibial plateau fractures (AO/OTA 41-B1.2, B1.3 h, B2.2. B3.2, and B3.3) between January 2013 and July 2017 were reviewed by three trauma fellowship-trained orthopedic surgeons to identify fractures of the medial condyle with an intact anterolateral articular surface. RESULTS Lateral plateau involvement was identified in 16 (37%) radiographs and 26 (61%) CT images (p = 0.051). Radiographic detection of lateral plateau involvement demonstrated a sensitivity of 62% and specificity of 100%, and radiographs were able to predict the recommendation for surgical intervention for lateral plateau involvement with a positive predictive value (PPV) of 75% and a negative predictive value (NPV) of 60% compared to recommendations based on CT imaging. Radiographs predicted a need for a separate surgical approach with PPV of 63% and NPV of 70% when compared to recommendations based on CT images. CONCLUSIONS Radiographs are reliable in ruling in lateral plateau involvement of medial plateau fractures, but occult lateral articular extension may only be identified in CT imaging for some cases. Surgical planning may be impacted by CT imaging for this fracture morphology, but further study is warranted to evaluate the correlation between preoperative planning and clinical outcomes. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Mary Kate Erdman
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, 1520 San Pablo Street, Los Angeles, CA, USA.
| | - Stephen J Gibbs
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, 1520 San Pablo Street, Los Angeles, CA, USA
| | - Douglass W Tucker
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Adam K Lee
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, 1520 San Pablo Street, Los Angeles, CA, USA
| | - Mark E Fleming
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, 1520 San Pablo Street, Los Angeles, CA, USA
| | - Geoffrey S Marecek
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
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Saragaglia D, Giunta JC, Gaillot J, Rubens-Duval B, Pailhé R. Are Schatzker and AO classifications accurate enough to classify tibial plateau fractures in alpine skiers? INTERNATIONAL ORTHOPAEDICS 2021; 45:1863-1869. [PMID: 33619586 DOI: 10.1007/s00264-021-04993-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/17/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The aims of this study were (1) to collect prospectively all tibial plateau fractures admitted to our department, over two ski seasons, and to classify them according to the Schatzker and AO classifications; (2) to assess if these classifications are accurate enough to include all types of fractures; and (3) to compare theses fractures with the series found in the literature, which included very few or no skiing accidents. METHODS During the 2016-2017 and 2017-2018 ski seasons, we prospectively included 116 tibial plateau fractures caused by downhill skiing accidents. All patients underwent standard X-rays and 2D and 3D CT scans. The fractures were classified according to the AO and Schatzker revisited classifications. RESULTS The full series consisted of 56 males (48%) and 60 females (52%), aged 49 ± 16 years (18-77). There were 60 type B (52%) and 56 type C fractures (48%) for AO classification and 45.5% types I, II and III and 54.5% types IV, V and VI for Schatzker classification. Thirty-five frontal fractures (30%) were not differentiated under the AO classification and, likewise, associated tibial spine fractures (28.5%) were not differentiated in the Schatzker classification. We were also unable to classify anterior tibial tuberosity fractures (14.5%) and fibula head fractures (8%). The anatomo-pathological types were not so different from road traffic accidents. CONCLUSION Contrary to our hypothesis, the anatomical-pathological damage in tibial plateau fractures resulting from downhill skiing accidents was barely any different from those found in road traffic accidents. However, despite progress in classifications with the emergence of 3D CT scans, it is still not always possible to categorise all fractures within a given classification.
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Affiliation(s)
- Dominique Saragaglia
- Department of Osteoarthritis and Sport Surgery, Grenoble-Alpes CHU, South Teaching Hospital, Kimberley Avenue, BP 338 38434, Échirolles Cedex, France.
- Grenoble-Alpes Medical Faculty, Service de Chirurgie Orthopédique, CHU Grenoble-Alpes site de Voiron, Route des Gorges, 38500, Voiron, France.
| | - J C Giunta
- Department of Osteoarthritis and Sport Surgery, Grenoble-Alpes CHU, South Teaching Hospital, Kimberley Avenue, BP 338 38434, Échirolles Cedex, France
| | - J Gaillot
- Department of Osteoarthritis and Sport Surgery, Grenoble-Alpes CHU, South Teaching Hospital, Kimberley Avenue, BP 338 38434, Échirolles Cedex, France
| | - B Rubens-Duval
- Department of Osteoarthritis and Sport Surgery, Grenoble-Alpes CHU, South Teaching Hospital, Kimberley Avenue, BP 338 38434, Échirolles Cedex, France
| | - R Pailhé
- Department of Osteoarthritis and Sport Surgery, Grenoble-Alpes CHU, South Teaching Hospital, Kimberley Avenue, BP 338 38434, Échirolles Cedex, France
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Abstract
Aims Tibial plateau fractures (TPFs) are complex injuries around the knee caused by high- or low-energy trauma. In the present study, we aimed to define the distribution and frequency of TPF lines using a 3D mapping technique and analyze the rationalization of divisions employed by frequently used classifications. Methods In total, 759 adult patients with 766 affected knees were retrospectively reviewed. The TPF fragments on CT were multiplanar reconstructed, and virtually reduced to match a 3D model of the proximal tibia. 3D heat mapping was subsequently created by graphically superimposing all fracture lines onto a tibia template. Results The cohort included 405 (53.4%) cases with left knee injuries, 347 (45.7%) cases with right knee injuries, and seven (0.9%) cases with bilateral injuries. On mapping, the hot zones of the fracture lines were mainly concentrated around the anterior cruciate ligament insertion, posterior cruciate ligament insertion, and the inner part of the lateral condyle that extended to the junctional zone between Gerdy’s tubercle and the tibial tubercle. Moreover, the cold zones were scattered in the posteromedial fragment, superior tibiofibular syndesmosis, Gerdy’s tubercle, and tibial tubercle. TPFs with different Orthopaedic Trauma Association/AO Foundation (OTA/AO) subtypes showed peculiar characteristics. Conclusion TPFs occurred more frequently in the lateral and intermedial column than in the medial column. Fracture lines of tibial plateau occur frequently in the transition zone with marked changes in cortical thickness. According to 3D mapping, the four-column and nine-segment classification had a high degree of matching as compared to the frequently used classifications. Cite this article: Bone Joint Res 2020;9(6):258–267.
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Affiliation(s)
- Xiang Yao
- Department of Orthopaedics, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Kaihua Zhou
- Department of Orthopaedics, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China.,Department of Orthopaedics, the First Affilated Hospital of Soochow University, Soochow, China
| | - Bin Lv
- Department of Orthopaedics, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Lei Wang
- Department of Orthopaedics, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Jun Xie
- Department of Orthopaedics, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Xingli Fu
- Jiangsu University Health Science Center, Zhenjiang, China
| | - Jishan Yuan
- Department of Orthopaedics, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China
| | - Yingqi Zhang
- Department of Orthopaedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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Two column classification of tibial plateau fractures; description, clinical application and reliability. Injury 2019; 50:1247-1255. [PMID: 31040027 DOI: 10.1016/j.injury.2019.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 04/19/2019] [Accepted: 04/21/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE In this era of life highly comminuted and multi planar tibial plateau fractures involving the posterior corners are more commonly seen and addressed in the literature than before. Among these several types have not been described in the currently used classification systems. In fact simple classification systems ignore several fracture types and leniently grouped the fractures with different mechanism, morphology, treatment modalities and prognosis in same category. On the other hand, more extensive nature classifications with detailed subdivisions are difficult to remember for clinicians. The clinical reliability of these classifications is another problem. All these issues demand the potential need of a new classification. The aim of this study was to describe a quadrant specific two column classification of tibial plateau fractures and to analyse its inter-observer and intra-observer reliability, clinical assessment and application. MATERIALS AND METHODS From January 2009 to December 2015, 44 patients with tibial plateau fractures were studied retrospectively. The antero-posterior (AP), lateral X-rays and computed tomography (CT) with axial transverse, sagittal, coronal and three dimensional (3D) reconstruction images were performed for all the patients. All of the fractures were categorized according to quadrant specific two column classification and the traditional Schatzker's classification. The comparative analysis for inter-observer and intra-observer reliability of the new classification and the Schatzker's classification was conducted by four observers. RESULTS Three cases didn't match any type in the Schatzker's classification. While on the other hand, all cases were classified by two column classification. The mean kappa values for inter-observer reliability by using the Schatzker's classification was 0.723 (range, 0.674-0.823), representing substantial agreement, whereas the mean kappa value was 0.939 (range: 0.897-0.974), representing almost perfect agreement according to two column classification. The mean kappa values for intra-observer reliability using the Schatzker's classification and two column classification were 0.789 (range: 0.590-0.864) and 0.955 (range:0.923-0.948) showing substantial agreement and almost perfect agreement. CONCLUSION The quadrant specific two column classification is anatomically oriented, CT based and clinically valid. The different fracture types according to anatomic location are represented alphanumerically so that treatment matched to specific fracture type (quadrant specific anatomic fixation) for optimal outcomes. Furthermore, it demonstrates higher inter-observer and intra-observer reliability. This classification can be adopted to strengthen the traditional Schatzker's classification, particularly in the multi planar and posteriorly extended plateau fractures. It can be used as a reliable research tool. The database can be used to distinguish different fracture types, individual type incidences, specific treatment and also prognosis. Authors suggest a large multi-centre study.
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Yao X, Xu Y, Yuan J, Lv B, Fu X, Wang L, Yang S, Meng S. Classification of tibia plateau fracture according to the "four-column and nine-segment". Injury 2018; 49:2275-2283. [PMID: 30270010 DOI: 10.1016/j.injury.2018.09.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/31/2018] [Accepted: 09/09/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE The existing classification systems of tibial plateau fracture (TPF) are suboptimal for clinical use and academic communication. A more comprehensive and universal classification system with the capability to analyze all patterns of TPF is urgently required to guide the clinical practice. This study aimed to analyze the incidence and fracture characteristics of TPF using a computed tomography-based "four-column and nine-segment" classification. METHODS According to the differentiated morphological characteristics, tibial plateau and proximal fibula were divided into four columns, which were subdivided into nine segments. Tibia plateau injury index (TPII) was innovatively introduced to represent the extent of injury. A total of 698 consecutive adult patients with 704 affected knees were included (377 females, 321 males, mean age 51.6 ± 12.9 years). Fracture mapping was retrospectively analyzed according to the new-style classification system based on the CT imaging. RESULTS 371 (53.2%) left knees and 321 (46.0%) right knees were injured solely and 6 (0.9%) cases sustained bilateral injuries. The rates of one-column, two-column, three-column and all-four-column injuries were 30.5%, 31.5%, 28.0% and 9.9%, respectively. On average, 2.2 ± 1.0 columns and 3.6 ± 2.1 segments were involved, the mean TPII was 5.7 ± 3.0. The rates of mild, moderate and severe comminuted fractures were 50.0%, 37.5% and 12.5%. The most frequently affected columns were lateral column (572, 81.3%) and intermedial column (524, 74.4%), and the less frequently involved columns were the medial column (219, 31.1%) and fibular column (218, 31.0%). The most frequently affected segments were the posterolateral segment (465, 66.1%), anterolateral segment (453, 64.3%) and posteromedian segment (379, 53.8%). The least frequently involved segment was tubercle segment (85, 12.1%). CONCLUSIONS The novel "four-column and nine-segment" classification will be a beneficial classification system for clinical diagnosis, statistical analysis and prognostic judgment of tibial plateau fractures.
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Affiliation(s)
- Xiang Yao
- Department of Orthopedics, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu Province, China
| | - Yong Xu
- Department of Orthopedics, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu Province, China
| | - Jishan Yuan
- Department of Orthopedics, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu Province, China
| | - Bin Lv
- Department of Orthopedics, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu Province, China
| | - Xingli Fu
- Jiangsu University Health Science Center, Zhenjiang, Jiangsu Province, China
| | - Lei Wang
- Department of Orthopedics, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu Province, China
| | - Shengquan Yang
- Department of Orthopaedics, The No.1 People's Hospital of Yancheng, Yancheng, Jiangsu Province, China
| | - Sheng Meng
- Department of Orthopedics, The Affiliated People's Hospital with Jiangsu University, Zhenjiang, Jiangsu Province, China.
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