The pivotal role of the coronal fracture line for a new three-dimensional CT-based fracture classification of bicondylar proximal tibial fractures

Pätzold, Robert; Friederichs, Jan; Rüden, Christian von; Panzer, Stephanie; Bühren, V.; Augat, Peter

doi:10.1016/j.injury.2017.06.019

Cited by 29 publications

(32 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Tibial plateau fractures are articular injuries which have a broad spectrum of clinical presentations and are frequently associated with long term complications [1,2]. In recent years these challenging fractures have become a topic of great interest not only regarding their classification but also fixation methods and expected outcomes [3][4][5][6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Revisiting the Schatzker classification of tibial plateau fractures

Kfuri

Schatzker

2018

Injury

186

143

View full text Add to dashboard Cite

A B S T R A C TTibial plateau fractures have a broad spectrum of presentations, depending on the mechanism and energy of the trauma. Many classification systems are currently available to describe these injuries. In 1974, Schatzker proposed a classification based on a two-dimensional representation of the fracture. His classification with the six-principles types became one of the most utilized classification systems for tibial plateau fractures. More than four decades after this original publication, we are revisiting each fracture type in the light of information made available by computed tomography, which today comprises a standard tool in assessing articular fractures. The classification we are proposing relies on the fact that the tibial plateau has two anatomical columns, lateral and medial. We are introducing a virtual equator which splits the articular surface in the coronal plane. The equator divides each column into two quadrants, the anterior (A) and the posterior (P). Unicondylar fracture types (I to IV) have now additional modifiers A (anterior) and P (posterior) to describe the exact spatial location of the primary fracture plane. Bicondylar fracture types (V and VI) have the modifiers (A and P) of the main fracture plane for each column, and lateral (L) and medial (M) to denote the column. We are introducing the concept of the main fracture plane. Recognition of the exact location of the principal fracture plane is essential for preoperative planning of patient positioning, surgical approach and for determining where to apply the hardware to achieve stable fixation. The new three-dimensional classification is based on the template of the original Schatzker classification. It covers the mechanism of the injury, the energy of the trauma, the morphologic characteristics of the fracture and its location in three dimensions.

show abstract

Section: Introductionmentioning

confidence: 99%

Revisiting the Schatzker classification of tibial plateau fractures

Kfuri

Schatzker

2018

Injury

186

143

View full text Add to dashboard Cite

show abstract

“…Operation time, blood loss, bone union time, and the degrees of knee extension and flexion were indices of the outcome. The final clinical outcomes of knee were evaluated by Knee Society Knee (KSS) [9,10]. The outcomes were categorized as excellent (80-100 points), good (70-79 points), fair (60-69 points), or poor (< 60 points).…”

Section: Evaluation Of Outcomementioning

confidence: 99%

Combined lateral peripatellar and posteromedial approaches for Schatzker type IV tibial plateau fractures involving posteromedial plane: A prospective study.

Zhang¹,

Yin

Zhao³

et al. 2020

Preprint

View full text Add to dashboard Cite

ObjectiveThe objective of this study to evaluate prospectively the effectiveness of Schatzker type IV tibial plateau fractures involving posteromedial plane managed by combined lateral peripatellar and posteromedial approaches Materials and methodsWe analyzed 18 patients with Schatzker type IV tibial plateau fractures involving posteromedial plane.There were 12 males and 6 females with an average of 38.5 years (range, 25-60 years). The mechanism of injury included traffic accident in 15 patients and falling in 3 patients. The injured lower limbs were right in 11 patients and left in 7 patients. The mean time from injury to surgery was 6.78 days (range, 5-9 days). There were 8 patients with meniscus injuries in our study. ResultsThe mean operation time was 3.41 hours (range, 3-4 hours). The mean blood loss was 352.78 ml (range, 300-410 ml). All the injured meniscuses were repaired. All patients were followed up, and the average time of follow up was 16.61 months (range, 14-22 months). Bone union was achieved at a mean of 12 weeks (range, 10-14 weeks). The mean degree of knee extension was 1.11° (range, 0-5°), and the mean degree of knee flexion was 120.56°(range, 110-130°). The mean points of KSS were 83

show abstract

“…Patzold et al [28] described the difference in medial plateau fracture line orientation in 81 BTPFs and classified the fractures based on the fracture line angle (sagittal fracture line, coronal fracture line, or no fracture line in the medial plateau). As described by Patzold, in the axial plane, a coronal fracture line (60°-120° relative to the sagittal plane) in the medial plateau fracture type was accompanied by a sagittal fracture line in the lateral plateau, which is consistent with the fracture line morphology resulting from the extension injury mechanism in the current study.…”

Section: Flexion-external Rotation Injury Mechanismmentioning

confidence: 99%

Bicondylar Tibial Plateau Fractures Involving the Posterior Fragment: Injury Mechanism and Fracture Characteristics

Pan

Peng

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Bicondylar tibial plateau fracture (BTPF) involving the posterior fragment is the most complex intra-articular fracture to treat. Although the fracture characteristics of BTPFs have been reported by many researchers, due to the sophisticated kinematics of the knee, reports focused on the injury mechanism are still scarce. The current injury mechanism is insufficient to explain the various fracture characteristics and to guide surgery. This study used a three-dimensional (3D) simulation method to investigate the injury mechanism and fracture characteristics of BTPFs involving the posterior fragment. Methods: Ninety-six BTPFs involving the posterior fragment were included. A computer-assisted 3D technique, which enabled us to move the femoral condyles to match the displaced fracture fragments of the tibial plateau, was applied to analysis the injury mechanism for all cases. The 3D and two-dimensional (2D) morphology of each fracture were reviewed thoroughly, and the main fracture lines were mapped and superimposed on a template. Results: After simulation and quantitatively analysis, three main types (extension, flexion-internal rotation, flexion-external rotation) and six sub-types (valgus and varus in each main type) of injury mechanism had been classified according to the degree of knee motion in three planes. In the extension type, femoral condyles compress the anterolateral tibial plateau and central medial plateau, resulting in an anterior-to-posterior fracture line. In the flexion-internal rotation type, the compressed areas are located on the posterolateral and anteromedial plateau, forming an oblique anteromedial-to-posterolateral fracture line. In the flexion-external rotation type, the compressed areas are located on the anterolateral and posteromedial plateau, exhibiting an anterolateral-to-posteromedial fracture line. Conclusions: Different injury mechanisms result in different fracture characteristics. A thorough understanding of the injury mechanisms underlying complex BTPFs involving the posterior fragment is meaningful not only for fracture characteristics reorganization but also for surgical decision making. The 3D simulation method employed in this study may be a useful supplemental method for investigating the mechanisms underlying fracture injuries.

show abstract

The pivotal role of the coronal fracture line for a new three-dimensional CT-based fracture classification of bicondylar proximal tibial fractures

Cited by 29 publications

References 24 publications

Revisiting the Schatzker classification of tibial plateau fractures

Revisiting the Schatzker classification of tibial plateau fractures

Combined lateral peripatellar and posteromedial approaches for Schatzker type IV tibial plateau fractures involving posteromedial plane: A prospective study.

Bicondylar Tibial Plateau Fractures Involving the Posterior Fragment: Injury Mechanism and Fracture Characteristics

Contact Info

Product

Resources

About