Zhang Yu, Song Lijun, Li Xiang, Fang Jiahu
Department of Trauma, the First Affiliating Hospital of Nanjing Medical University & Jiangsu Province Hospital, China.
Injury. 2018 Apr;49(4):852-859. doi: 10.1016/j.injury.2018.03.009. Epub 2018 Mar 7.
The authors have identified a subset of unicondylar tibial plateau depression fracture patterns caused by a flexion-valgus force. The purpose of this study was to describe this fracture pattern and suggest a modified lateral approach that may allow for improved reduction and stabilization.
The preoperative radiographs and CT scans of 102 patients who sustained unicondylar tibial plateau fractures (OTA 41B) were reviewed. Twenty-six fracture patients had posterolateral (PL) tibial plateau depression fractures. By medical record review and telephone follow-up, the injury mechanism of the 22 unicondylar tibial plateau fractures was confirmed as a flexion-valgus force. The radiographic features of those cases were analyzed and measured. To address this specific fracture pattern, a modified approach combined with a novel intra-articular osteotomy was applied.
According to the morphological characteristics, this tibial plateau fracture pattern could be divided into two subtypes: type A was a confined, basin-like articular surface depression fracture located in the PL quadrant, and type B was a cancellous fracture involving the PL tibial plateau resulting in a decrease in the posterior slope. One radiographic hallmark of this fracture pattern is an anatomically or a mechanically intact posterior column wall. The novel approach was applied to both types. The postoperative radiographic measurements revealed excellent reduction quality. On axial scans, the distance between the most posterior rafting screw and the tangent line of the tibial plateau rim was 3.0 ± 2.07 mm (from -1.9 to 4.3), and the angulation between them was 8.9 ± 3.02° (from -7.3 to 15.6). These results indicated excellent PL quadrant coverage from the rafting screws.
Flexion-valgus force-induced unicondylar tibial plateau depression fracture is a unique injury pattern. We suggest a novel surgical approach to address this injury's key features, which may facilitate exposure and enhance fixation strength.
作者已识别出由屈膝外翻力导致的单髁胫骨平台凹陷骨折的一个子集。本研究的目的是描述这种骨折类型，并提出一种改良的外侧入路，该入路可能有助于改善骨折复位和固定效果。
回顾了102例单髁胫骨平台骨折（OTA 41B）患者的术前X线片和CT扫描结果。26例骨折患者为胫骨平台后外侧（PL）凹陷骨折。通过病历回顾和电话随访，确认22例单髁胫骨平台骨折的损伤机制为屈膝外翻力。对这些病例的影像学特征进行了分析和测量。针对这种特定的骨折类型，采用了一种改良入路并结合一种新型关节内截骨术。
根据形态学特征，这种胫骨平台骨折类型可分为两个亚型：A型为局限于PL象限的盆状关节面凹陷骨折，B型为累及PL胫骨平台的松质骨骨折，导致后倾角减小。这种骨折类型的一个影像学特征是后柱壁在解剖学上或力学上完整。两种类型均采用了这种新型入路。术后影像学测量显示骨折复位质量极佳。在轴向扫描中，最靠后的支撑螺钉与胫骨平台边缘切线之间的距离为3.0±2.07mm（范围为-1.9至4.3），两者之间的成角为8.9±3.02°（范围为-7.3至15.6）。这些结果表明支撑螺钉对PL象限的覆盖良好。
屈膝外翻力导致的单髁胫骨平台凹陷骨折是一种独特的损伤类型。我们建议采用一种新型手术入路来处理这种损伤的关键特征，这可能有助于显露并增强固定强度。
