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

Abstract

Background. The aim of the study was to assess the outcomes of surgical treatment of complex knee injuries with a posterior inverted-L approach to the knee joint. Material and methods. The study retrospectively enrolled 13 patients who underwent surgical treatment due to knee injuries with posterior tibial plateau fractures in 2015-2017. Pre-operative planning was based on antero­po­sterior and lateral X-rays and CT images. The fracture was assessed according to Luo’s three-column classification. Radiographic postoperative assessment was based on lower limb (standing) X-rays and measurements of the MPTA, aPPTA, JLCA, and aFaT angles in the operated and healthy limbs. Clinical assessment was based on the IKDC, KOOS, and Tegner-Lysholm Knee Scoring Scale. Results. Mean follow-up duration was 11.5 months (4-25 months). Anatomical joint surface reduction was achiev­ed in 12 patients and bone union was present in all patients. A posterior inverted-L approach was used in 9 pa­tients and combined approaches in 8 patients. According to the three-column classification, single-column fractures were found in 3 patients, two-column fractures in 4, and three-column fractures in 6 patients. The KOOS was 82%, the IKDC score was 80%, and the Tegner-Lysholm score was 82 points. Radiographic assessments of the operated knee joints showed an MPTA of 88.64 degrees, aPPTA of 79.78 degrees, JLCA of 0.8 degrees, and aFaT of 7.9 degrees. Conclusions. 1. Anatomical reduction and stable fixation of posterior plateau fractures of the proximal tibia are crucial in fracture management. 2. A posterior inverted-L approach is very useful when treating posterior tibial plateau fractures.

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

“…In addition, the anatomical resolution of X-ray is low due to the overlapping of the patient's bone structures [ 4 ]. Especially when the fracture plane is an inclined plane and the articular surface of the tibial plateau collapses, the tissue overlap will lead to the inability to accurately and effectively distinguish the joint injury [ 5 ]. Therefore, further arthroscopy is still needed to confirm KI in such patients, which will not only bring secondary trauma to patients with severe bone trauma but also increase the risk of fracture infection and thrombosis [ 6 ].…”

3D mapping and classification of tibial plateau fractures

“…When the TPFs involved the posteromedial fragment, PCL insertion, and posterolateral compression, the posterior inverted L-shaped approach was recommended for addressing these three common posterior injuries. 36 - 38 …”

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

“…Thus, research on typing and subtypes of Schatzker IV type fractures is intensive (9,10) and there are numerous treatment methods (11)(12)(13). However, clinical reports on the typing and treatment of extended tibial plateau fractures are rare (14,15). Extended tibial plateau fractures cannot be fully explained by Schatzker typing, Moore typing or AO/OTA typing (16); therefore, these fractures have been named hyperextension varus bicondylar tibial plateau (HEVBTP) fractures, the characteristics of which are as follows: Loss of posterior slope angle (PSA), a posterior cortical tension fracture, compression of the anterior bone and varus deformity.…”

“…As a special type of fracture, tibial plateau fractures involving the anteromedial margin caused by a hyperextension varus injury in a clinical setting have rarely been reported in the literature (16). This type of fracture is usually caused by serious, violent injury and is characteristic of endangering the medial column, posterior column or even the three columns of the tibial plateau, which complicate the injury of the medial and lateral meniscus, posterolateral complex and posterior cruciate ligament (14,21). The key to surgical treatment of tibial plateau fractures involving the anteromedial margin caused by a hyperextension varus injury is the accurate reduction of the posterior cortex and the effective support and fixation of the anterior compression bone, particularly the reduction and strong fixation of the anteromedial comminuted bone, which is a difficulty for the treatment of this type of fracture.…”