R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland, School of Medicine, Baltimore, Maryland, United States.
R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland, School of Medicine, Baltimore, Maryland, United States.
Injury. 2021 Jul;52(7):1944-1950. doi: 10.1016/j.injury.2021.04.013. Epub 2021 Apr 7.
Tibial plateau fractures are a heterogenous group of injuries with a variable amount of articular injury and are commonly associated with lateral sided articular impaction. Previous work has focused on describing the morphology of tibial plateau fractures, but has neglected description of medial sided articular impaction. The aim of this investigation was to assess the morphology of medial sided articular impaction in tibial plateau fractures, with specific attention directed toward the frequency, location, size, and associated fracture patterns.
Skeletally mature patients presenting to a Level I trauma center from 2008-2018 with a tibial plateau fracture (AO/OTA 41B-C) were identified retrospectively. Fractures were classified by AO/OTA and Schatzker type. Radiographs and computed tomography (CT) scans were reviewed to identify and localize medial sided articular impaction. The location and surface area of impaction was characterized by creating frequency diagram heat maps from axial CT scans. Descriptive statistics were performed using standard measures.
Of the 1032 tibial plateau fractures included, 82 (7.9%) were noted to have medial sided articular impaction. Rate of impaction varied by fracture type (p = 0.03): Schatzker II, 2% (7 of 381); Schatzker IV, 21% (19 of 96); and Schatzker VI, 11% (56 of 524). Average total surface area of impaction was 9% of the total and 19% of the medial plateau area. Area of impaction varied by fracture type (p = 0.004): Schatzker II, 6% (95% confidence interval [CI], 4%-7%); Schatzker IV, 11% (95% CI, 9%-13%), and Schatzker VI, 9% (95% CI, 7%-11%). The area of impaction occurred primarily along the lateral aspect of the medial plateau in Schatzker II fractures, in the anteromedial quadrant of Schatzker IV fractures, and was evenly distributed across the medial plateau in Schatzker VI fractures.
Surgeons should be aware that medial articular impaction is present in approximately 8% of tibial plateau fractures. Schatzker IV fractures are most likely to have medial impaction and a larger proportion of the joint surface involved in these injuries.
胫骨平台骨折是一组异质性损伤，其关节损伤程度不一，常伴有外侧关节面撞击。既往研究主要集中于胫骨平台骨折的形态学描述，而忽略了内侧关节面撞击的描述。本研究旨在评估胫骨平台骨折中内侧关节面撞击的形态学特征，尤其关注撞击的频率、位置、大小及相关骨折类型。
回顾性分析 2008 年至 2018 年期间在一家 I 级创伤中心就诊的胫骨平台骨折（AO/OTA 41B-C）患者，这些患者均为骨骼成熟患者。骨折按 AO/OTA 和 Schatzker 分型进行分类。通过 X 线和 CT 扫描评估并定位内侧关节面撞击。撞击的位置和表面积通过创建 CT 轴位扫描的频率图热图进行特征描述。使用标准测量法进行描述性统计。
在纳入的 1032 例胫骨平台骨折中，82 例（7.9%）存在内侧关节面撞击。撞击发生率因骨折类型而异（p=0.03）：Schatzker II 型为 2%（381 例中的 7 例）；Schatzker IV 型为 21%（96 例中的 19 例）；Schatzker VI 型为 11%（524 例中的 56 例）。撞击的总表面积平均占胫骨平台总面积的 9%，占内侧平台面积的 19%。撞击面积因骨折类型而异（p=0.004）：Schatzker II 型为 6%（95%置信区间，4%-7%）；Schatzker IV 型为 11%（95%置信区间，9%-13%）；Schatzker VI 型为 9%（95%置信区间，7%-11%）。Schatzker II 型骨折中撞击主要发生在胫骨平台内侧的外侧，Schatzker IV 型骨折中撞击发生在前内侧象限，Schatzker VI 型骨折中撞击则均匀分布于整个内侧胫骨平台。
外科医生应意识到约 8%的胫骨平台骨折存在内侧关节面撞击。Schatzker IV 型骨折最有可能发生内侧撞击，且关节面的更大比例受累。
