Establishment of Classification of Tibial Plateau Fracture Associated with Proximal Fibular Fracture

Overview

Journal Orthop Surg

Specialty Orthopedics

Date 2019 Feb 9

PMID 30734492

Citations 8

Authors

Zhan-le Zheng

Yi-Yang Yu

Heng-Rui Chang

Huan Liu

Hui-Lin Zhou

Ying-Ze Zhang

Affiliations

Soon will be listed here.

Abstract

Objective: The purpose of this retrospective study was to determine the incidence of fibular fractures as an associated injury in tibial plateau fractures according to CT scan. We also attempt to introduce a new morphological sub-classification on this associated injury and to analyze the correlation between this classification and tibial plateau fractures.

Methods: We selected cases with fibular fractures from all the tibial plateau fracture patients. The cases were further divided into 2 groups: unicondylar group and bicondylar group. On the basis of our new classification system of fibular fracture, all the included cases were divided into 5 subgroups.

Results: Finally, a total of 150 cases associated with fibular fractures in 502 tibial plateau fracture cases were identified from our institution database. The incidence of fibular head fracture in tibial plateau fractures was 29.88% (150/502). Seventy-one cases (47.3%) were involved one condyle, and 79 cases (52.7%) involved both. It shows significant difference in the subgroup of avulsion fracture with horizontal fracture line (Type A) which is ratio of 16.9% in unicondylar group and 1.27% in bicondylar group.

Conclusion: A new classification of this associated injury describing the morphology of the fracture fragments may improve operative planning.

Citing Articles

Effect of Schatzker type VI tibial plateau fractures combined with a proximal fibular and/or posterolateral joint facet fracture on early postoperative functional recovery.

Wang X, Yang H, Xu C, Xu X, Zhang C, Jing J J Orthop Surg Res. 2023; 18(1):412.

PMID: 37287007 PMC: 10246155. DOI: 10.1186/s13018-023-03887-2.

Do associated proximal fibula fractures help predict the severity of tibial plateau fractures?.

Mackie D, Mitchell B, Siow M, Onodera K, Berger G, Kent W Eur J Orthop Surg Traumatol. 2023; 33(7):2959-2963.

PMID: 36917285 PMC: 10504102. DOI: 10.1007/s00590-023-03513-1.

Flexion Tibial Plateau Fractures: 3-dimensional CT Simulation-based Subclassification by Injury Pattern.

Hu Y, Peng A, Wang S, Pan S, Zhang X Orthop Surg. 2022; 14(3):543-554.

PMID: 35132782 PMC: 8926999. DOI: 10.1111/os.13190.

A New Three-Dimensional Classification of Proximal Tibiofibular Fractures: A Multicenter Study.

Wu L, Mayr H, Cai Q, Huan Y, Zhu X, Chen Y Orthop Surg. 2021; 13(8):2442-2456.

PMID: 34672099 PMC: 8654672. DOI: 10.1111/os.13161.

Classification and Treatment Strategies of Concomitant Fibular Column Injuries in Tibial Plateau Fractures.

Yao X, Lv B, Hu M, Yuan J, Fan X, Zhou K Biomed Res Int. 2021; 2021:2698642.

PMID: 34532498 PMC: 8440093. DOI: 10.1155/2021/2698642.

References

Huang G, Yu J, Munshi M, Chan W, Lee C, Chen C . Avulsion fracture of the head of the fibula (the "arcuate" sign): MR imaging findings predictive of injuries to the posterolateral ligaments and posterior cruciate ligament. AJR Am J Roentgenol. 2003; 180(2):381-7. DOI: 10.2214/ajr.180.2.1800381. View

Ross G, DeConciliis G, Choi K, Scheller A . Evaluation and treatment of acute posterolateral corner/anterior cruciate ligament injuries of the knee. J Bone Joint Surg Am. 2005; 86-A Suppl 2:2-7. DOI: 10.2106/00004623-200412002-00002. View

Zhang H, Hong L, Wang X, Zhang J, Liu X, Feng H . All-arthroscopic repair of arcuate avulsion fracture with suture anchor. Arthroscopy. 2011; 27(5):728-34. DOI: 10.1016/j.arthro.2010.11.004. View

Kumar G, Peterson N, Narayan B . Bicondylar tibial fractures: Internal or external fixation?. Indian J Orthop. 2011; 45(2):116-24. PMC: 3051117. DOI: 10.4103/0019-5413.77130. View

Ariffin H, Mahdi N, Rhani S, Baharudin A, Shukur M . Modified hybrid fixator for high-energy Schatzker V and VI tibial plateau fractures. Strategies Trauma Limb Reconstr. 2011; 6(1):21-6. PMC: 3058182. DOI: 10.1007/s11751-011-0105-4. View

Babis G, Evangelopoulos D, Kontovazenitis P, Nikolopoulos K, Soucacos P . High energy tibial plateau fractures treated with hybrid external fixation. J Orthop Surg Res. 2011; 6:35. PMC: 3161896. DOI: 10.1186/1749-799X-6-35. View

Ramos T, Ekholm C, Eriksson B, Karlsson J, Nistor L . The Ilizarov external fixator--a useful alternative for the treatment of proximal tibial fractures. A prospective observational study of 30 consecutive patients. BMC Musculoskelet Disord. 2013; 14:11. PMC: 3639146. DOI: 10.1186/1471-2474-14-11. View

Ferreira N, Marais L . Bicondylar tibial plateau fractures treated with fine-wire circular external fixation. Strategies Trauma Limb Reconstr. 2014; 9(1):25-32. PMC: 3951617. DOI: 10.1007/s11751-014-0185-z. View

Pun T, Krishnamoorthy V, Poonnoose P, Oommen A, Korula R . Outcome of Schatzker type V and VI tibial plateau fractures. Indian J Orthop. 2014; 48(1):35-41. PMC: 3931151. DOI: 10.4103/0019-5413.125490. View

10.

Zhu Y, Meili S, Dong M, Zhai Q, Yao L, Wang J . Pathoanatomy and incidence of the posterolateral fractures in bicondylar tibial plateau fractures: a clinical computed tomography-based measurement and the associated biomechanical model simulation. Arch Orthop Trauma Surg. 2014; 134(10):1369-80. DOI: 10.1007/s00402-014-2037-1. View

11.

Macdonald P, Vo A . Complications of posterolateral corner injuries of the knee and how to avoid them. Sports Med Arthrosc Rev. 2014; 23(1):51-4. DOI: 10.1097/JSA.0000000000000049. View

12.

Sharma N, Singh V, Agrawal A, Bhargava R . Proximal tibial fractures with impending compartment syndrome managed by fasciotomy and internal fixation: A retrospective analysis of 15 cases. Indian J Orthop. 2015; 49(5):502-9. PMC: 4598540. DOI: 10.4103/0019-5413.164044. View

13.

Mardian S, Landmann F, Wichlas F, Haas N, Schaser K, Schwabe P . Outcome of angular stable locking plate fixation of tibial plateau fractures Midterm results in 101 patients. Indian J Orthop. 2016; 49(6):620-9. PMC: 4705728. DOI: 10.4103/0019-5413.168755. View

14.

Khatri K, Lakhotia D, Sharma V, Kiran Kumar G, Sharma G, Farooque K . Functional Evaluation in High Energy (Schatzker Type V and Type VI) Tibial Plateau Fractures Treated by Open Reduction and Internal Fixation. Int Sch Res Notices. 2016; 2014:589538. PMC: 4897230. DOI: 10.1155/2014/589538. View

15.

Tao X, Chen N, Pan F, Cheng B . External fixation combined with delayed internal fixation in treatment of tibial plateau fractures with dislocation. Medicine (Baltimore). 2017; 96(41):e8221. PMC: 5662313. DOI: 10.1097/MD.0000000000008221. View

16.

Bertrand M, Pascual-Lopez F, Guerado E . Severe tibial plateau fractures (Schatzker V-VI): open reduction and internal fixation versus hybrid external fixation. Injury. 2017; 48 Suppl 6:S81-S85. DOI: 10.1016/S0020-1383(17)30799-4. View

17.

Garnavos C . Intramedullary Nailing with a Suprapatellar Approach and Condylar Bolts for the Treatment of Bicondylar Fractures of the Tibial Plateau. JB JS Open Access. 2018; 2(2):e0017. PMC: 6132469. DOI: 10.2106/JBJS.OA.16.00017. View

18.

Capps G, Hayes C . Easily missed injuries around the knee. Radiographics. 1994; 14(6):1191-210. DOI: 10.1148/radiographics.14.6.7855335. View

19.

Green N, Allen B . Vascular injuries associated with dislocation of the knee. J Bone Joint Surg Am. 1977; 59(2):236-9. View