Pan Shuo, Peng A-Qin, Hu Ya-Ning, Wang Shuai, Zhang Yan-Long, Wang Yong
Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
Ann Transl Med. 2021 Feb;9(4):302. doi: 10.21037/atm-20-5043.
Tibial plateau fractures involving the posterior plateau (TPFIPs) are complex intra-articular fractures that are difficult to stabilize. Understanding the characteristics of these fractures together with the injury pattern is beneficial for surgeons to choose an optimal treatment strategy. However, the complicated morphology and injury patterns of TPFIPs are poorly characterized. The purpose of this retrospective study was to investigate the injury patterns and fracture characteristics of complex TPFs by applying three-dimensional (3D) simulation and fracture mapping methods.
In total, 171 TPFIPs were retrospectively reviewed, and the injury pattern was simulated and analyzed by applying a 3D method with Mimics software, which allowed matching of the fractured articular surfaces of the tibial plateau to the femoral condyle surface. The major articular fracture lines were mapped and then superimposed on a template. The tibial motion angle after fracture injury pattern simulation and the major fracture line angle were quantitatively analyzed, while the injury patterns and fracture characteristics were qualitatively analyzed.
Four main injury patterns with distinctive fracture characteristics were observed in this study. In total, 72 TPFs exhibited extension as the pattern of injury with a split posterolateral fragment, and 61 fractures exhibited the flexion-internal rotation injury pattern; compression was the main feature of posterolateral fractures. Furthermore, 21 fractures exhibited the flexion-external rotation injury pattern, with a small posteromedial fragment, and 17 fractures exhibited the flexion-neutral injury pattern, with both parts of the posterior plateau fracture and anterior dislocation being observable. The major articular fracture line angles were significantly different between the four main injury patterns (85.92°, 46.79°, 148.26°, and 16.21°, median values, P<0.05). Two injury patterns, namely, flexion-internal rotation and flexion-external rotation, exhibited rotation in the axial plane (24.13°±8.33°, -15.13°±5.14°, P<0.05).
In this study, a method involving a simulated injury pattern was developed and combined with evaluations of fracture characteristics, including two-dimensional (2D) and 3D analyses, to comprehensively describe both the morphologies and injury patterns of TPFIPs.
累及后平台的胫骨平台骨折（TPFIPs）是复杂的关节内骨折，难以实现稳定固定。了解这些骨折的特征以及损伤模式有助于外科医生选择最佳治疗策略。然而，TPFIPs复杂的形态和损伤模式目前描述甚少。本回顾性研究的目的是通过应用三维（3D）模拟和骨折映射方法来研究复杂胫骨平台骨折的损伤模式和骨折特征。
总共回顾了171例TPFIPs，并通过使用Mimics软件的3D方法对损伤模式进行模拟和分析，该方法可使胫骨平台骨折的关节面与股骨髁表面匹配。绘制主要关节骨折线，然后叠加在模板上。对骨折损伤模式模拟后的胫骨运动角度和主要骨折线角度进行定量分析，同时对损伤模式和骨折特征进行定性分析。
本研究观察到四种主要损伤模式，具有独特的骨折特征。总共72例胫骨平台骨折表现为伸展型损伤模式，伴有后外侧骨折块分离，61例骨折表现为屈曲 - 内旋损伤模式；压缩是后外侧骨折的主要特征。此外，21例骨折表现为屈曲 - 外旋损伤模式，伴有小的后内侧骨折块，17例骨折表现为屈曲 - 中立损伤模式，后平台骨折的两部分及前方脱位均可见。四种主要损伤模式之间的主要关节骨折线角度有显著差异（中位数分别为85.92°、46.79°、148.26°和16.21°，P<0.05）。两种损伤模式，即屈曲 - 内旋和屈曲 - 外旋，在轴向平面上存在旋转（分别为24.13°±8.33°、-15.
