University of Southern California, Los Angeles, CA.
Foot Ankle Int. 2013 Oct;34(10):1421-6. doi: 10.1177/1071100713491561. Epub 2013 May 29.
The objective of this study was to determine whether there is a difference in fracture pattern and severity of comminution between tibial plafond fractures with and without associated fibular fractures using computed tomography (CT). We hypothesized that the presence of an intact fibula was predictive of increased tibial plafond fracture severity.
This was a case control, radiographic review performed at a single level I university trauma center. Between November 2007 and July 2011, 104 patients with 107 operatively treated tibial pilon fractures and preoperative CT scans were identified: 70 patients with 71 tibial plafond fractures had associated fibular fractures, and 34 patients with 36 tibial plafond fractures had intact fibulas. Four criteria were compared between the 2 groups: AO/OTA classification of distal tibia fractures, Topliss coronal and sagittal fracture pattern classification, plafond region of greatest comminution, and degree of proximal extension of fracture line.
The intact fibula group had greater percentages of AO/OTA classification B2 type (5.5 vs 0, P = .046) and B3 type (52.8 vs 28.2, P = .013). Conversely, the percentage of AO/OTA classification C3 type was greater in the fractured fibula group (53.5 vs 30.6, P = .025). Evaluation using the Topliss sagittal and coronal classifications revealed no difference between the 2 groups (P = .226). Central and lateral regions of the plafond were the most common areas of comminution in fractured fibula pilons (32% and 31%, respectively). The lateral region of the plafond was the most common area of comminution in intact fibula pilon fractures (42%). There was no statistically significant difference (P = .71) in degree of proximal extension of fracture line between the 2 groups.
Tibial plafond fractures with intact fibulas were more commonly associated with AO/OTA classification B-type patterns, whereas those with fractured fibulas were more commonly associated with C-type patterns. An intact fibula may be predictive of less comminution of the plafond. The lateral and central regions of the plafond were the most common areas of comminution in tibial plafond fractures, regardless of fibular status.
Level III, case control study.
本研究旨在通过计算机断层扫描（CT）确定是否存在合并腓骨骨折与不合并腓骨骨折的胫骨平台骨折在骨折形态和粉碎程度方面的差异。我们假设腓骨完整可预测胫骨平台骨折的严重程度增加。
这是一项单中心、病例对照、影像学回顾性研究。在 2007 年 11 月至 2011 年 7 月期间，共发现 104 例手术治疗的胫骨 Pilon 骨折患者，术前均行 CT 扫描：70 例患者（71 例）存在合并腓骨骨折，34 例患者（36 例）存在完整腓骨。在这两组患者中，比较了以下 4 项标准：胫骨远端的 AO/OTA 分类、Topliss 冠状面和矢状面骨折形态分类、粉碎最严重的平台区域以及骨折线近端延伸程度。
腓骨完整组的 AO/OTA 分类 B2 型（5.5%对 0%，P =.046）和 B3 型（52.8%对 28.2%，P =.013）的比例更高。相反，腓骨骨折组的 AO/OTA 分类 C3 型比例更高（53.5%对 30.6%，P =.025）。使用 Topliss 矢状面和冠状面分类评估时，两组之间无差异（P =.226）。在腓骨骨折的胫骨平台中，中央和外侧平台是最常见的粉碎区域（分别为 32%和 31%）。在腓骨完整的胫骨平台骨折中，外侧平台是最常见的粉碎区域（42%）。两组间骨折线近端延伸程度无统计学差异（P =.71）。
腓骨完整的胫骨平台骨折更常见于 AO/OTA 分类 B 型模式，而腓骨骨折的胫骨平台骨折更常见于 C 型模式。腓骨完整可能预示着平台的粉碎程度较低。无论腓骨情况如何，胫骨平台骨折最常见的粉碎区域均为平台的外侧和中央区域。
III 级，病例对照研究。
