Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, No. 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
J Orthop Sci. 2021 Sep;26(5):831-843. doi: 10.1016/j.jos.2020.08.008. Epub 2020 Sep 17.
The Wahlquist system classifies tibial medial plateau fractures into three types based on the sagittal fracture line location, with type C at highest risk of complications. However, the injury mechanism of tibial medial plateau fractures, especially tibial rotation movement, remains unclear. The purpose of the present study was to determine the injury patterns of medial tibial plateau fractures using 3D model simulation and quantitative 3D measurements.
Seventy-eight consecutive AO/OTA type 41-B tibial plateau fractures were retrospectively analyzed using CT-based 3D models and quantitative 3D measurements. The knee posture at the moment of fracture occurrence was simulated, and various knee angles in the sagittal, coronal, and axial planes were measured to evaluate the mechanism of medial tibial plateau fracture. The mean valgus-varus, hyperextension-flexion, and internal-external rotation angles were determined, and the chi-square test was used for comparisons of categorical varus and valgus force data to determine the main force direction in Wahlquist type C fractures.
Angle measurements in the coronal planes showed that 28 (35.9%) medial tibial plateau fractures resulted from a varus injury pattern, while 50 fractures (64.1%) resulted from a valgus pattern. Valgus force produced significantly more Wahlquist type C fractures (37 of 50 fractures) than varus force (2 of 28 fractures) (p < 0.05). There was no significant difference in the cases of patients with type C fractures between the tibial internal and external rotation injury patterns(P > 0.05).
Valgus force was the cause of 64.1% of the medial tibia plateau fractures in the present cohort. Furthermore, valgus force produced more Wahlquist type C fractures than varus force. The present findings will help orthopedists understand the injury mechanism of the Wahlquist classification system, and will facilitate the identification of the common features of medial tibial plateau fractures induced by specific injury patterns.
Wahlquist 系统根据矢状骨折线位置将胫骨内侧平台骨折分为三型，C 型骨折并发症风险最高。然而，胫骨内侧平台骨折的损伤机制，特别是胫骨旋转运动，仍不清楚。本研究旨在通过 3D 模型模拟和定量 3D 测量来确定内侧胫骨平台骨折的损伤模式。
回顾性分析了 78 例连续的 AO/OTA 41-B 型胫骨平台骨折患者，使用基于 CT 的 3D 模型和定量 3D 测量。模拟骨折发生时的膝关节姿势，测量矢状面、冠状面和轴面的各种膝关节角度，以评估内侧胫骨平台骨折的机制。测量平均外翻-内翻、过伸-过屈和内外旋转角度，并使用卡方检验比较分类的内翻和外翻力数据，以确定 Wahlquist 型 C 骨折的主要作用力方向。
冠状面角度测量显示，28 例（35.9%）内侧胫骨平台骨折由内翻损伤模式引起，50 例（64.1%）由外翻损伤模式引起。外翻力导致明显更多的 Wahlquist 型 C 骨折（50 例中的 37 例）比内翻力（28 例中的 2 例）多（p<0.05）。在 C 型骨折患者中，胫骨内旋和外旋损伤模式之间无显著差异（P>0.05）。
外翻力是本队列中内侧胫骨平台骨折的 64.1%的原因。此外，外翻力比内翻力导致更多的 Wahlquist 型 C 骨折。本研究结果将有助于骨科医生了解 Wahlquist 分类系统的损伤机制，并有助于识别特定损伤模式引起的内侧胫骨平台骨折的常见特征。
