Difficulties in Treating Complex Knee Injuries with Fracture of Posterior Tibial Plateau

Application of Low-Dose CT and MRI in the Evaluation of Soft Tissue Injury in Tibial Plateau Fractures

Objective

To explore the application value of low-dose CT and MRI in the evaluation of soft tissue injury in tibial plateau fractures.

Methods

This study included 89 patients with high suspicion of TPF and KI admitted to our hospital from July 2015 to May 2021. After arthroscopy, 81 patients were diagnosed with FTP combined with KI. The Schatzker classification based on X-ray and CT plain scan combined with three-dimensional reconstruction was recorded, and the soft tissue injury was recorded according to the MRI examination of the affected knee joint.

Results

With the results of pathological examination and arthroscopic surgery as the gold standard, the results of MRI and pathological examination and arthroscopic examination were in good agreement (Kappa = 0.857, 0.844), and CT was moderately in agreement (Kappa = 0.697, 0.694). In KI examination, CT and MRI had no difference in the evaluation of ligament injury and bone injury (P > 0.05), but MRI had better diagnostic effect on meniscus injury (P < 0.05). Finally, the satisfaction survey showed that patients in the CT group were more satisfied with clinical services (P < 0.05).

Conclusion

Both CT and MRI have certain diagnostic value for occult tibial plateau fractures, among which CT examination is more advantageous for trabecular bone fractures, MRI examination is more advantageous for cortical bone fractures, and MRI examination can improve occult tibial plateau fracture inspection accuracy.

Effects of Surgical Treatment Guided by the Three-Column Classification Method on Knee Joint Function and Postoperative Complications in Patients with Tibial Plateau Fractures

Many patients with tibial plateau fractures present with various degrees of soft tissue contusion and severely damaged articular surface, ligament, and vascular nerves, and thus how to treat this kind of patient has become one of the great difficulties in clinical practice. Therefore, we aim to investigate the effects of surgical treatment guided by the three-column classification method on knee joint function and postoperative complications in patients with tibial plateau fractures. A total of 120 patients with three-column tibial plateau fractures admitted to our hospital from January 2018 to January 2019 were selected and divided into group A (n = 60) and group B (n = 60). Among them, the group A patients were treated with an anterior lateral approach in floating positions combined with reduction plate internal fixation with an L-shaped approach in the posteromedial joint, while the patients in group B received reduction plate internal fixation with a knee midline incision in supine positions. After that, the perioperative indexes, knee function scores, the MOS item short-from health survey (SF-36) scores, complication rate (CR), and overall treatment efficacy of the patients were compared between the two groups. The perioperative indexes in group A were significantly better than those in group B (P < 0.001); the knee function scores and SF-36 scores in group A were significantly higher than those in group B (P < 0.001); the CR in group A was significantly lower than that in group B (P < 0.001); the treatment efficacy in group A was significantly better than that in group B (P < 0.05). The three-column classification method, with highly instructive significance in tibial plateau fracture surgery, can improve treatment efficacy and reduce the incidence of complications, which is worthy of application and promotion in clinical practice.

Joint line plate fixation for tibial plateau fractures caused by hyperextension varus

The present study evaluated the outcomes of internal fixation with a joint line plate in the treatment of tibial plateau fractures caused by hyperextension of the varus. The study included 25 cases (13 males and 12 females; age, 19-71 years) of tibial plateau fracture caused by hyperextension of the varus, which were treated at Puai Hospital, Tongji Medical College (Wuhan, China) between January 2015 and June 2017. Fractures were treated with internal fixations of the inner cortex with a self-clipped joint line plate made of steel. After the surgery, patients were examined immediately and at 3, 6 and 12 months. Healing was evaluated by X-ray examination. All cases were cured during follow-up. After surgery, one patient developed partial necrosis of the skin margin of the incision and recovered after a dressing change. Furthermore, one patient with a concomitant peroneal nerve injury and hypoesthesia recovered after treatment with neurotrophic drugs. No screw loosening, fractures or failure of the internal fixations occurred. According to the X-ray results, there were significant differences in the tibial plateau angle (TPA) and medial posterior slope angle (m-PSA) between the pre-operative stage and 12 months post-operatively (P<0.05). However, no significant differences in either the TPA or m-PSA were present between the immediate post-operative stage and 12 months post-operatively (P>0.05). In conclusion, internal fixation with a joint line plate is an appropriate treatment for tibial plateau fractures involving the anteromedial margin with good clinical efficacy.

3D mapping and classification of tibial plateau fractures

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.