Morphological characteristics of split-depression fractures of the lateral tibial plateau (Schatzker type II): a computer-tomography–based study

Abstract

Purpose The objective of this study was to evaluate the morphological characteristics of lateral tibial plateau splitdepression fractures (Schatzker type II). Methods A retrospective analysis of radiographic and computed tomographic (CT) data of lateral tibial plateau splitdepression fractures from January 2009 to December 2010 was conducted in a level 1 trauma centre. The discontinuity arc, angle of depression centre (ADC), anterior-posterior position of articular depression centre (APDC), surface area percentage (SAP), sagittal angulation and depression depth were measured on CT images using the Picture Archiving and Communication System. Results Based on the integrity of posterolateral wall and discontinuity arc, 140 cases of Schatzker type II fracture were divided into two subtypes: intact group (69 cases) and broken group (71 cases). The fracture of the intact group was located in the anterior part of the lateral plateau, the average ADC was 72.13°, APDC was 43.25 % of sagittal diameter, SAP was 22.16 % of total plateau, sagittal angulation was 6.59°and depression depth was 10.80 mm. Of the broken group, the average ADC, APDC, SAP, sagittal angulation and depression depth was 92.45°, 61.84 %, 22.63 %, 9.00°and 10.78 mm, respectively. Forty-seven cases in the broken group had a posterolateral fragment and 15 cases among them had articular depression centered in the posterolateral region. The difference in ADC, APDC and sagittal angulation between the two groups was statistically significant (p<0.05), while no significant difference was observed for SAP and depression depth. Conclusions Of all the 140 cases in this study, 10.7 % are located in the posterolateral region. An appropriate operative approach and fixation method should be selected based on the individual morphological characteristics of lateral plateau fractures.

The İmpact of Obesity on the Outcomes of the Patients that Operated due to Schatzker Type I and II ?

“…[18,19] Bize başvuran tibia plato kırkları da literatürle uyumlu olarak yüksek oranda Schatzker tip I ve tip II kırıklardan oluştu. [18] Tibia plato Schatzker tip I ve tip II kırıklarda posterolateral fragmanın önemli olduğunu ve cerrahi tedavide ihmal edilmemesi gerektiğini unutmamak gerekir. Uygun eklem restorasyonu ancak ameliyat öncesi iyi planlama ile mümkün olacağından hastalarda cerrahi öncesi bilgisayarlı tomografi (BT) ile değerlendirilmelidir.…”

“…Uygun eklem restorasyonu ancak ameliyat öncesi iyi planlama ile mümkün olacağından hastalarda cerrahi öncesi bilgisayarlı tomografi (BT) ile değerlendirilmelidir. [18] Biz olgularımızın tamamında plan radyografilerle beraber BT görüntülemelerini de rutin olarak yaptık ve literatürde tanımlanan algoritma ile cerrahi tedavilerimizi gerçekleştirdik. [20,21] Brennan ve ark.…”

“…[21] Schatzker tip II kırık olan hastalarda klinik ve radyolojik sonuçların olumsuz olmasında ana etkenin obezite olduğu göze çarpmaktadır. [18] Bu da obez hastalarda travma sonucu oluşan kırık paterninin nonobez hastalara göre daha kötü olduğunu göstermektedir. Bulgularımız da Maheshwari ve ark.…”

“…Tip II kırıklardaki bu farklılığın kırık paterninden kaynaklandığını düşünmekteyiz. [18,30] Schatzker tip I kırık minimal deplase kama şeklinde kırık olup sıklıkla genç hasta gurubundadır. Schatzker tip II kırık ise valgus zorlanmasıyla depresyonun eşlik ettiği, beraberinde de ligament ve menisküs yaralanmalarının eşlik ettiği ileri yaş osteoporozlu hastalarda görülen bir kırık tipidir.…”

Letter to the Editor: Surgical Technique: Tscherne-Johnson Extensile Approach for Tibial Plateau Fractures

“…Chang et al [1] performed a CT-based measurement on eight patients and reported the average articular depression depth was 10.5 mm. Zhai et al [6] studied the fragment morphology in 71 patients and found that the posterolateral articular depression was 10.78 ± 2.05 mm, and the fractured surface area was 22.63% ± 7.85% of the total tibial plateau. Xiang et al [5] demonstrated that the posterolateral articular depression was 10.5 ± 5.2 mm (range, 2 mm to 19 mm), and the fracture fragments comprised a mean 14.3% ± 6.3% of the total articular surface (range, 8%-32%).…”