The distinct prediction standards for radiological assessments associated with soft tissue injuries in the acute tibial plateau fracture

Abstract

The goal of this study was to assess the incidence of soft tissue injury in the tibial plateau fracture by magnetic resonance image (MRI) and reveal the relationship between the articular widening/depression and the risk of meniscus and ligament disorder. A total of 54 patients with tibial plateau fracture were indicated for operative intervention. Soft tissue injuries were assessed by MRI. Meniscus, anterior/posterior cruciate ligaments and medial/lateral collateral ligaments injuries on MRI were evaluated. The articular widening/depression was measured in picture archiving and communication systems. Schatzker classification of fracture types was not significantly associated with soft tissue injuries. The rates of soft tissue injury in types IV and II (respectively, 85.7 and 74.1 %) were higher than those in other types. The meniscus injury was the most common soft tissue damage, and the incidence of meniscus injury was 55.6 %. When LPDCT and LPWCT were, respectively, about 7.6 mm and 10.1 mm and LPDX-ray and LPWX-ray, respectively, 5.6 and 7.4 mm, more attention should be paid on the collateral and cruciate ligament injuries in types I, II and III. Furthermore, when LPWCT and LPWX-ray were, respectively, about 10.3 and 8.6 mm, the collateral and cruciate ligaments were susceptible to injury in types IV and V. In conclusion, tibial plateau fracture can occur high morbidity of soft tissue injury, including meniscus and ligament disorder. X-ray and CT scan had different predicting standards for soft tissue injury, and the articular widening/depression in the tibial plateau was associated with meniscus and ligament injuries.

Defining the width of the normal tibial plateau relative to the distal femur: Critical normative data for identifying pathologic widening in tibial plateau fractures

“…While many surgeons use a subjective assessment of widening when indicating patients for surgical treatment, a threshold LPW >5 mm has also been proposed in the literature (Honkonen, ; Parkkinen et al, ). This value was established through studies demonstrating associated soft tissue injuries at this threshold, but clear outcomes data on the amount of acceptable widening have yet to be established (Gardner et al, ; Durakbasa et al, ; Wang et al, ). Our results are also directly applicable to the intra‐operative assessment of reduction quality in tibial plateau fractures.…”

“…Durakbasa et al () demonstrated that a preoperative LPW >10 mm was predictive of lateral meniscal injury through intraoperative direct visualization. Wang et al () were unable to predict soft tissue injury on the basis of tibial plateau widening. The variation noted in this study could explain the discrepancy in results among earlier studies.…”

Incidence and Radiological Predictors of Concomitant Meniscal and Cruciate Ligament Injuries in Operative Tibial Plateau Fractures: A Prospective Diagnostic Study

“…Several studies have reported correlations between radiological assessments and soft-tissue injuries in lateral tibial plateau fractures 11 – 14 , 24 . Gardner et al .…”

“…Because of the high-energy shearing and compressive stress exerted on the knee joint, menisci and ligaments are at considerable risk for injury, the overall incidence of which has been reported to be 39% to 99% and 16.7% to 57%, respectively 1 , 3 – 10 . Several authors have reported that soft tissue injury occurred more frequently with increasing displacement of tibial plateau fractures 11 – 14 . However, previous retrospective studies relied on data mostly obtained from MR images or arthroscopic findings.…”

Tibial Plateau Fracture

“…Poor functional outcomes and a high incidence of meniscal pathology have led many authors to suggest a condylar width increase of >5 mm and varus/valgus instability >5° as an indication for surgery [38,72,79]. However, Wang et al [87] were unable to predict soft tissue injury based on tibial plateau widening. Johannsen et al [14] suggest that discrepancies in the literature on condylar widening can be reconciled by instead using a ratio of the articular widths of the femur and tibia in order to minimize problems in measurement with magnification and calibration.…”