Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, 110029, India.
Department of Mechanical Engineering, Indian Institute of Technology, New Delhi, 110016, India.
Eur J Orthop Surg Traumatol. 2023 Oct;33(7):3001-3010. doi: 10.1007/s00590-023-03520-2. Epub 2023 Mar 19.
One of the major limitations of the 2D fracture evaluation (Schatzker classification) is its failure to adequately assess fracture lines in the frontal plane and fracture displacement in the antero-posterior direction. 3D fracture line mapping includes steric assessment which can aid decision making with regards to the surgical approach and fixation scheme. We hypothesized that there are consistent fracture patterns and zones of comminution for proximal tibial fractures.
Radiographic data of 228 proximal tibia fractures were retrospectively included in this study. Fracture lines and zones of comminution were graphically superimposed onto a 3D template of an intact tibia after virtual reduction and normalization to identify major patterns of fracture and comminution.
Out of 206 male and 21 female patients, 89 had a fracture of the lateral condyle only (Schatzker I and II), 53 involved the medial plateau only (Schatzker IV) and 86 had a high-grade fracture involving both the condyles (Schatzker V and VI). 64.5% of the fracture lines involving the medial plateau alone were in the coronal plane, and this number was even lesser (44.2%) in medial plateau involvement of bicondylar fractures. In bicondylar fractures, lines were usually not seen to pass directly through the posteromedial region.
Medial tibial plateau fractures have a mix of coronal or sagittal fracture alignment. A clearer understanding of the 3D orientations of fractures based on CT scans can aid in diagnosing the pattern of fracture and adequate positioning of plates can be done to eventually improve operative outcomes.
二维骨折评估（Schatzker 分类）的主要局限性之一是无法充分评估额状面的骨折线和前后方向的骨折移位。三维骨折线绘图包括空间评估，有助于针对手术入路和固定方案做出决策。我们假设胫骨近端骨折存在一致的骨折模式和粉碎区域。
本研究回顾性纳入了 228 例胫骨近端骨折的影像学资料。在虚拟复位和归一化后，将骨折线和粉碎区域图形叠加到完整胫骨的 3D 模板上，以识别主要的骨折和粉碎模式。
206 名男性和 21 名女性患者中，89 例仅有外侧髁骨折（Schatzker I 和 II），53 例仅有内侧平台骨折（Schatzker IV），86 例有涉及双侧髁的高级别骨折（Schatzker V 和 VI）。单独累及内侧平台的骨折线中，有 64.5%位于冠状面，而在双髁受累的内侧平台骨折中，这一数字甚至更小（44.2%）。在双髁骨折中，通常看不到骨折线直接穿过后内侧区域。
胫骨内侧平台骨折有冠状或矢状骨折对线的混合。根据 CT 扫描更清楚地了解骨折的 3D 方向有助于诊断骨折模式，并可以正确定位钢板，最终改善手术结果。
