University of Texas, Southwestern Medical Center, 5325 Harry Hines Blvd, Dallas, Texas 75390, USA.
Bone Joint J. 2013 Dec;95-B(12):1697-702. doi: 10.1302/0301-620X.95B12.32016.
Bicondylar tibial plateau fractures result from high-energy injuries. Fractures of the tibial plateau can involve the tibial tubercle, which represents a disruption to the extensor mechanism and logically must be stabilised. The purpose of this study was to identify the incidence of an independent tibial tubercle fracture in bicondylar tibial plateau fractures, and to report management strategies and potential complications. We retrospectively reviewed a prospectively collected orthopaedic trauma database for the period January 2003 to December 2008, and identified 392 bicondylar fractures of the tibial plateau, in which 85 tibial tubercle fractures (21.6%) were identified in 84 patients. There were 60 men and 24 women in our study group, with a mean age of 45.4 years (18 to 71). In 84 fractures open reduction and internal fixation was undertaken, either with screws alone (23 patients) or with a plate and screws (61 patients). The remaining patient was treated non-operatively. In all, 52 fractures were available for clinical and radiological assessment at a mean follow-up of 58.5 weeks (24 to 94). All fractures of the tibial tubercle united, but 24 of 54 fractures (46%) required a secondary procedure for their tibial plateau fracture. Four patients reported pain arising from prominent tubercle plates and screws, which in one patient required removal. Tibial tubercle fractures occurred in over one-fifth of the bicondylar tibial plateau fractures in our series. Fixation is necessary and can be reliably performed with screws alone or with a screw and plate, which restores the extensor mechanism and facilitates early knee flexion.
双髁胫骨平台骨折由高能损伤引起。胫骨平台骨折可累及胫骨结节,这代表伸肌机制中断,逻辑上必须稳定。本研究的目的是确定双髁胫骨平台骨折中独立胫骨结节骨折的发生率,并报告治疗策略和潜在并发症。我们回顾性地审查了 2003 年 1 月至 2008 年 12 月期间前瞻性收集的骨科创伤数据库,并确定了 392 例双髁胫骨平台骨折,其中 84 例患者有 85 例胫骨结节骨折(21.6%)。研究组中有 60 名男性和 24 名女性,平均年龄为 45.4 岁(18 至 71 岁)。84 例骨折中,有 23 例单独采用螺钉,61 例采用钢板和螺钉进行切开复位内固定。其余患者接受非手术治疗。在所有患者中,有 52 例在平均 58.5 周(24 至 94 周)的随访时进行了临床和影像学评估。所有胫骨结节骨折均愈合,但 54 例骨折中有 24 例(46%)需要进行二次手术治疗胫骨平台骨折。4 名患者报告从突出的结节板和螺钉处出现疼痛,其中 1 名患者需要取出。在我们的系列中,超过五分之一的双髁胫骨平台骨折发生了胫骨结节骨折。固定是必要的,可以单独用螺钉或螺钉和钢板可靠地进行,这可以恢复伸肌机制并有利于早期膝关节弯曲。