Fractures of the tibial plateau involve similar energies as the tibial pilon but greater articular surface involvement

Abstract

Patients with tibial pilon fractures have a higher incidence of post-traumatic osteoarthritis than those with fractures of the tibial plateau. This may indicate that pilon fractures present a greater mechanical insult to the joint than do plateau fractures. We tested the hypothesis that fracture energy and articular fracture edge length, two independent indicators of severity, are higher in pilon than plateau fractures. We also evaluated if clinical fracture classification systems accurately reflect severity. Seventy-five tibial plateau fractures and fifty-two tibial pilon fractures from a multi-institutional study were selected to span the spectrum of severity. Fracture severity measures were calculated using objective CT-based image analysis methods. The ranges of fracture energies measured for tibial plateau and pilon fractures were 3.2 to 33.2 Joules (J) and 3.6 to 32.2 J, respectively, and articular fracture edge lengths were 68.0 to 493.0 mm and 56.1 to 288.6 mm, respectively. There were no differences in the fracture energies between the two fracture types, but plateau fractures had greater articular fracture edge lengths (p<0.001). The clinical fracture classifications generally reflected severity, but there was substantial overlap of fracture severity measures between different classes. Clinical Significance Similar fracture energies with different degrees of articular surface involvement suggest a possible explanation for dissimilar rates of post-traumatic osteoarthritis for fractures of the tibial plateau compared to the tibial pilon. The substantial overlap of severity measures between different fracture classes may well have confounded prior clinical studies relying on fracture classification as a surrogate for severity.

Inflammatory cytokine response is greater in acute tibial plafond fractures than acute tibial plateau fractures

“…Our definition of high‐energy may have impacted the finding that we were unable to detect a difference in the inflammatory marker concentration between high‐energy and low‐energy injuries. Some researchers have begun to quantify fracture energy through CT scans and this may be a more objective method of comparing energy of injury . Also, while we only included patients who were less than 24 h from injury, inflammatory cytokines concentrations can change within a matter of hours.…”

“…Some researchers have begun to quantify fracture energy through CT scans and this may be a more objective method of comparing energy of injury. 23,24 Also, while we only included patients who were less than 24 h from injury, inflammatory cytokines concentrations can change within a matter of hours. In this study, the timedependent concentration alterations may be limited by CYTOKINES PLAFOND AND PLATEAU FRACTURES our narrow inclusion criteria and by the fact that our biomarker measurements were done on joint fluid from a relatively closed compartment.…”

Correlation of Fracture Energy With Sanders Classification and Post-traumatic Osteoarthritis After Displaced Intra-articular Calcaneus Fractures

“…Fracture classification systems are often used to provide a clinician-assessed indicator of fracture severity but suffer from poor inter-observer reliability when clinicians' place fracture patterns into categorical classification schemes. 3,4 This study demonstrated poor inter-observer reliability in classifying DICAFs by the Sanders Classification (concordance τ = 0.6, p=0.0074). The Sanders classification is commonly used to assess DIACFs and has been previously found to be prognostic of long-term patient outcomes.…”

“…The energy range for DIACFs was found to be 14.14-26.87 J. Dibbern, et al used a similar methodology and reported fracture energies for tibial plateau fractures (3.2-33.2 J) and for pilon fractures (3.6-32.2 J). 3 Thomas et al reported pilon fracture energy range from 5.2-27.2 J. 1 Compared to plateau and pilon fractures, the energy range for calcaneus fractures appears to be narrower and focused on the upper end of the spectrum, suggesting it may take consistently more energy to break the calcaneus.…”

“…CT-based methods for quantifying fracture energy have previously been described for tibial plateau and pilon fractures. [1][2][3] Fracture energy as a measure of severity may improve upon current fracture classification systems, which are categorical and prone to poor inter-observer reliability. 4 Displaced intra-articular calcaneal fractures (DIACFs) frequently result in post-traumatic osteoarthritis (PTOA).…”