Vogel Michael, Hoffman Alexander, Revak Thomas
Department of Orthopaedic Surgery, Saint Louis University School of Medicine, St. Louis, Missouri.
OTA Int. 2024 Jul 12;7(3):e341. doi: 10.1097/OI9.0000000000000341. eCollection 2024 Sep.
The objectives of this study were to describe the incidence and morphology of medial tibial plateau fractures that extend into the lateral articular surface and to describe trends in their management.
Retrospective.
Level I Urban Trauma Center.
Seventy consecutive patients sustaining OTA/AO 41 B1 and B3 fractures.
Open reduction internal fixation of medial tibial plateau fractures.
Incidence of medial tibial plateau fractures that extend into the lateral articular surface. Secondary outcomes include localization of lateral articular surface depression, neurovascular injury, and trends in surgical management.
Seventy patients were included with 9 fractures (12.9%) isolated to the medial condyle (MC) and 61 fractures (87.1%) extending to the lateral condyle (LC). Compartment syndrome was present in 2 patients (2.9%), peroneal nerve palsy in 2 (2.9%), and arterial injury in 1 (1.4%). Initial external fixation was used more frequently in the LC group compared with the MC group ( = 0.028). Of the 61 fractures in the LC group, 49 (80.3%) included lateral articular surface depression which localized to the posteromedial quadrant of the lateral articular surface in 36 of 49 fractures (73.5%). Lateral articular surface depression depth ≥10.6 mm was associated with the use of dual incisions ( < 0.001).
Schatzker IV fractures frequently extend to the lateral condyle and often present with depression of the posteromedial lateral articular surface. Fractures with lateral articular surface depression depth ≥10.6 mm were more likely to undergo fixation with dual incisions.
Therapeutic level IV.
本研究的目的是描述延伸至外侧关节面的胫骨内侧平台骨折的发生率和形态，并描述其治疗趋势。
回顾性研究。
一级城市创伤中心。
连续70例遭受OTA/AO 41 B1和B3型骨折的患者。
胫骨内侧平台骨折切开复位内固定术。
延伸至外侧关节面的胫骨内侧平台骨折的发生率。次要观察指标包括外侧关节面凹陷的定位、神经血管损伤以及手术治疗趋势。
纳入70例患者，其中9例（12.9%）骨折仅累及内侧髁（MC），61例（87.1%）骨折延伸至外侧髁（LC）。2例（2.9%）患者出现骨筋膜室综合征，2例（2.9%）出现腓总神经麻痹，1例（1.4%）出现动脉损伤。与MC组相比，LC组更频繁地使用初始外固定（P = 0.028）。在LC组的61例骨折中，49例（80.3%）包括外侧关节面凹陷，其中49例中的36例（73.5%）位于外侧关节面的后内侧象限。外侧关节面凹陷深度≥10.6 mm与采用双切口固定相关（P < 0.001）。
Schatzker IV型骨折常延伸至外侧髁，且常伴有外侧关节面后内侧凹陷。外侧关节面凹陷深度≥10.6 mm的骨折更有可能采用双切口固定。
治疗性IV级。
