Anne and Robert H. Lurie Children's Hospital of Chicago, Chicago, USA.
Department of Orthopedic Surgery, University of California, 200 West Arbor Drive, San Diego, CA, 92103, USA.
Eur J Orthop Surg Traumatol. 2023 Oct;33(7):2959-2963. doi: 10.1007/s00590-023-03513-1. Epub 2023 Mar 14.
Proximal fibula fractures are often associated with tibial plateau fractures, but their relationship is poorly characterized. The purpose of this study was to better define the relationship between tibial plateau injury severity and presence of associated soft tissue injuries.
A retrospective review was performed on all operatively treated tibial plateau fractures at a Level 1 trauma center over a 5-year period. Patient demographics, injury radiographs, CT scans, operative reports and follow-up were reviewed.
Queried tibial plateau fractures from 2014 to 2019 totaled 217 fractures in 215 patients. Fifty-two percent were classified as AO/OTA 41B and 48% were AO/OTA 41C. Thirty-nine percent had an associated proximal fibula fracture. The presence of a proximal fibula fracture had significant correlation with AO/OTA 41C fractures, as compared with AO/OTA 41B fractures (chi-square, p < 0.001). Of the patients with a lateral split depression type tibial plateau fracture, the presence of a proximal fibula fracture was associated with more articular comminution, measured by number of articular fragments (mean = 4.0 vs. 2.9 articular fragments, p = 0.004). There was also a higher rate of meniscal injury in patients with proximal fibula fractures (37% vs. 20%, p = 0.003).
There was a significant relationship between the higher energy tibial plateau fracture type (AO/OTA 41C) and the presence of an associated proximal fibula fracture. The presence of a proximal fibula fracture with a tibial plateau fracture is an indicator of a higher energy injury and a higher likelihood of meniscal injury.
腓骨近端骨折常与胫骨平台骨折相关，但两者之间的关系尚未得到充分描述。本研究旨在更好地定义胫骨平台损伤严重程度与伴发软组织损伤之间的关系。
对一家一级创伤中心 5 年内所有接受手术治疗的胫骨平台骨折患者进行回顾性研究。回顾患者的人口统计学资料、影像学检查、CT 扫描、手术报告和随访情况。
2014 年至 2019 年共检索到 215 例患者的 217 例胫骨平台骨折。52%的骨折为 AO/OTA 41B 型，48%为 AO/OTA 41C 型。39%的患者合并腓骨近端骨折。与 AO/OTA 41B 型骨折相比，AO/OTA 41C 型骨折更易合并腓骨近端骨折（卡方检验，p<0.001）。在外侧劈裂凹陷型胫骨平台骨折患者中，合并腓骨近端骨折与更多的关节面粉碎有关（平均关节面碎片数分别为 4.0 个和 2.9 个，p=0.004）。合并腓骨近端骨折的患者半月板损伤发生率也更高（37%比 20%，p=0.003）。
高能量胫骨平台骨折类型（AO/OTA 41C）与合并腓骨近端骨折之间存在显著关系。胫骨平台骨折合并腓骨近端骨折提示损伤能量更高，半月板损伤的可能性更大。
