Analysis of medial tibial plateau fracture injury patterns using quantitative 3D measurements

Wang, Shuai; Peng, Aqin; Pan, Shuo; Hu, Yaning; Zhang, Xiao; Gao, Jianguo

doi:10.1016/j.jos.2020.08.008

Cited by 7 publications

(13 citation statements)

References 14 publications

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“…In previous studies, the authors paid limited attention to tibial rotation when investigating the injury mechanism of tibial plateau fractures. 11 13 20 In our study, tibial rotation was added as a factor to investigate the injury mechanism. According to the results of our study, tibial rotation was not a significant factor in both producing associated ACL avulsions and affecting the degree of injuries ( p > 0.05).…”

Section: Discussionmentioning

confidence: 99%

The Relationship between the Injury Mechanism and the Incidence of ACL Avulsions in Schatzker Type IV Tibial Plateau Fractures: A 3D Quantitative Analysis Based on Mimics Software

et al. 2022

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Introduction Tibial plateau fractures are often accompanied with ligamental and meniscal injuries. Among which, the combined existence of Schatzker type IV fracture with anterior cruciate ligament (ACL) avulsion has been reported rarely. The purpose of this study was to determine the injury mechanism of Schatzker type IV fracture with ACL avulsion based on Mimics software. Methods Ninety-nine Schatzker type IV tibial plateau fractures were retrospectively analyzed by quantitative three-dimensional measurements. ACL avulsions were diagnosed through the data of computed tomography and magnetic resonance imaging. We simulated the knee posture when an injury occurred and defined different injury patterns. The chi-square test was used for determining the main mechanism which causes Schatzker type IV fractures associated with ACL avulsions. Results There were more ACL avulsions and more displaced ACL avulsions associated with the knee in flexion in the setting of Schatzker type IV fracture (p < 0.05). More ACL avulsions were found in the injury pattern of flexion-valgus than the other injury patterns of the same level (p < 0.05). The rotation of the tibial showed no significant difference in producing ACL avulsion fractures. Conclusion This study found that a flexed knee at the occurrence of a Schatzker type IV tibial plateau fracture is a high-risk factor for causing associated ACL avulsion and producing more displaced avulsions. Flexion-valgus pattern was the main cause of Schatzker type IV fractures associated with ACL avulsions. The findings will help orthopedists understand the injury mechanism and enhance their awareness of such injuries to avoid unfavorable prognosis.

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Section: Discussionmentioning

confidence: 99%

The Relationship between the Injury Mechanism and the Incidence of ACL Avulsions in Schatzker Type IV Tibial Plateau Fractures: A 3D Quantitative Analysis Based on Mimics Software

et al. 2022

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“…Many studies [8,14,27] have proposed the hypothesis that knee rotation might play a role in hyperextension TPFs, but no study has yet proved it with concrete evidence. According to our classification, the combined type fractures can indicate knee rotation because the different sizes of anterolateral and anteromedial fragments show the relative location between the femur and tibia when an injury occurs.…”

Section: Discussionmentioning

confidence: 99%

“…[6] Meanwhile, being an important risk factor for accelerated knee osteoarthritis, [7] it is rational to classify the fractures based on coronal deformities, but rotational force is another issue requiring consideration. [8] Currently, because of a lack of a commonly accepted classification system based on anatomic fracture Editor: Roxana Covali.…”

Section: Introductionmentioning

confidence: 99%

Different patterns of tibial plateau fractures associated with hyperextension injuries of the knee with or without varus/valgus component

et al. 2021

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This study aims to introduce a morphological classification of hyperextension tibial plateau fractures based on CT scans and to reveal the correlation between the anterior compression and posterior tension fractures. From January 2015 to January 2019, 37 patients with hyperextension tibial plateau fractures were studied retrospectively. Based on this classification, the fractures were divided into 2 groups: group A had anterolateral or anteromedial compression fractures while group B had both. Three observers classified the fractures and recorded the morphology and incidences of posterior plateau fractures and proximal fibular fractures. All 37 fractures were allocated to group A (n = 15; 40%) and B (n = 22; 60%). Of the posterior tibial plateau fractures, 10 (27%) fractures were defined as partial and 27 (73%) as total. Of the 37 fractures, 18 (49%) proximal fibular avulsion fractures were observed. There was a significant difference between groups A and B regarding the incidence of total posterior tibial plateau fractures ( P < .05). However, there was no significant difference between the incidence of proximal fibular avulsion fractures in the 2 groups or the combined and non-combined type fractures in group B ( P > .05). Hyperextension tibial plateau fractures with a decreased posterior slope angle always involve both the anteromedial and anterolateral plateaus. This CT-based classification may improve the understanding of fracture features and is helpful for planning treatment.

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“…But few papers put their attention to the injury mechanism associated with the classi cation. Our team member,Wang 10 , had explored the mechanism of Schatzker IV tibial plateau fractures by using CT-based 3D models and summarized eight possible injury patterns of Schatzker type IV tibial plateau fractures: hyperextension-varus-internal rotation, hyperextension-valgus-external rotation, extension-varus, extension-valgus, exion-varus-internal rotation, exion-varus-external rotation, exionvalgus-internal rotation and exion-valgus-external rotation.…”

Section: Introductionmentioning

confidence: 99%

“…In this study, we de ned the injury patterns as a new classi cation, named 3D-classi cation. Wang described the injury patterns based on 3D models by using Mimics software 10 . In order to make 3Dclassi cation intelligible, we generalized CT features of each injury pattern.…”

Section: Introductionmentioning

confidence: 99%

Introduction of 3D-classification and its derived surgical sequence of Schatzker type IV tibial plateau fractures

Liu

Wang

Wang³

et al. 2023

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Introduction Schatzker IV tibial plateau fractures usually have worse prognosis due to its high variability and the combination of bony and soft tissue injuries. The aim of this study was to introduce a new classification of Schatzker IV tibial plateau fractures based on the injury mechanism and evaluate its reliability. The secondary aim was to evaluate the outcomes of operative Schatzker IV tibial plateau fractures treated according to the surgical sequences which were determined by the new classification. Materials and Methods 63 operative Schatzker IV tibial plateau fractures which were treated following the new surgical sequence were enrolled in our study. CT images of these patients were reviewed and classified twice according to our new classification by four observers. The reliability of the classification was calculated by application of kappa analysis. The surgical sequence determined by the classification was evaluated by observing the the postoperative efficacy during the follow-up. Results The intra-observer reliability of 3D-classification showed excellent agreement according to Landis and Koch (The mean k = 0.897, CI 0.806–0.971). And the inter-obsever reliability of 3D-classification also showed excellent agreement. (The mean k = 0.883, CI 0.786–0.961). All patients were followed up and the average follow-up of the cases was 12.8 months (6–28 months). As for the evaluation of the postoperative efficacy, according to KSS, 53 cases were rated as excellent, 8 cases were rated as good and 2 cases were considered as fair results. Conclusions The new proposed classification showed high intra and inter-observer reliability in our study. And the surgical sequence determined by the classification can help surgeons to acquire good reduction and rigid internal fixation. Therefore the new classification of Schatzker IV tibial plateau fractures and the accompanied surgical sequence are worthy of further popularization and application in clinical trials.

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Analysis of medial tibial plateau fracture injury patterns using quantitative 3D measurements

Cited by 7 publications

References 14 publications

The Relationship between the Injury Mechanism and the Incidence of ACL Avulsions in Schatzker Type IV Tibial Plateau Fractures: A 3D Quantitative Analysis Based on Mimics Software

The Relationship between the Injury Mechanism and the Incidence of ACL Avulsions in Schatzker Type IV Tibial Plateau Fractures: A 3D Quantitative Analysis Based on Mimics Software

Different patterns of tibial plateau fractures associated with hyperextension injuries of the knee with or without varus/valgus component

Introduction of 3D-classification and its derived surgical sequence of Schatzker type IV tibial plateau fractures

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