NYU Langone Orthopedic Hospital, 301 E 17th St, NY, 10003, New York, USA.
Jamaica Hospital Medical Center, 8900 Van Wyck Expressway, Richmond Hill, NY, 11418, USA.
Eur J Orthop Surg Traumatol. 2023 Aug;33(6):2283-2290. doi: 10.1007/s00590-022-03421-w. Epub 2022 Nov 3.
The association of tibial shaft fractures (TSFs) with posterior malleolar fractures is well described. The purpose of this study was to identify specific radiographic parameters that are predictive of any pattern of associated distal intra-articular fractures in TSFs.
All TSFs presenting over a 6-year period were identified. A radiographic review of plain radiographs and CT scans included: identification of any associated ankle fracture, classification using the OTA System, measurements of the TSF obliquity angle (FOA), relative distance from distal extent of the TSF to plafond (DFP%), and presence and level of any associated fibular fractures. Patients with and without associated ankle fractures were statistically compared. Multivariate logistic regression determined independent predictors of associated ankle fractures.
405 TSFs in 397 patients were identified, with 145 TSFs with associated distal intra-articular fractures. There were 94 (23.2%) posterior malleolar fractures, 19 (13.1%) medial malleolar fractures, 42 (29.0%) lateral malleolar fractures involving the syndesmosis and 14 (9.7%) Chaput fragments. Multivariate regression demonstrated AO/OTA classification type 42-A1, 42-B1 or 42-C1 (OR 2.3 [95% CI 1.3-4.0]; p = 0.003), FOA greater than 45° (OR 2.7 [95% CI 1.5-4.8]; p = 0.001) and DFP% less than 33% (OR 4.1 [95% CI 2.0-9.0]; p = 0.005) were independent correlates of associated ankle fractures regardless of mechanism of injury.
Different patterns of intra-articular fractures beyond posterior malleolar fractures can occur in TSFs. Fracture angles greater than 45° and extent into the distal 33% of the tibial shaft are independent predictors of distal intra-articular fractures in TSFs regardless of mechanism of injury.
Diagnostic Level III.
胫骨骨干骨折（TSF）与后踝骨折的相关性已有充分描述。本研究的目的是确定可预测 TSF 中任何类型的相关关节内远端骨折的特定影像学参数。
回顾性分析了 6 年内所有 TSF 患者的 X 线和平扫 CT 资料，包括：是否存在相关踝关节骨折，采用 OTA 系统进行分类，测量 TSF 倾斜角（FOA）、胫骨骨干远端到距骨平台的相对距离（DFP%），以及是否存在和/或位于何处的腓骨骨折。比较有和无相关踝关节骨折的患者。多变量逻辑回归确定相关踝关节骨折的独立预测因子。
共纳入 397 例患者的 405 例 TSF，其中 145 例合并关节内远端骨折。94 例（23.2%）为后踝骨折，19 例（13.1%）为内踝骨折，42 例（29.0%）为累及下胫腓联合的外踝骨折，14 例（9.7%）为 Chaput 骨折。多变量回归分析显示，AO/OTA 分型 42-A1、42-B1 或 42-C1（OR 2.3 [95%CI 1.3-4.0]；p=0.003）、FOA 大于 45°（OR 2.7 [95%CI 1.5-4.8]；p=0.001）和 DFP%小于 33%（OR 4.1 [95%CI 2.0-9.0]；p=0.005）与踝关节骨折独立相关，与损伤机制无关。
除后踝骨折外，TSF 还可出现其他类型的关节内骨折。骨折角度大于 45°且累及胫骨骨干远端的 33%与损伤机制无关，是 TSF 关节内远端骨折的独立预测因子。
诊断 III 级。
