KU Leuven - University of Leuven, Faculty of Medicine, Leuven, Belgium.
University Hospitals Leuven, Department of Radiology, Leuven, Belgium.
Knee. 2024 Oct;50:9-17. doi: 10.1016/j.knee.2024.07.014. Epub 2024 Jul 31.
Defining the injury-force mechanism in tibial plateau fractures (TPFs) could help define implant type and position, as well as soft tissues at risk. The aim of this study was to provide an analysis of injury-force-mechanisms in TPFs, including axial rotation.
The injury-force mechanism was determined for 203 fractures that presented over a period of 3.5 years. Fractures were classified as flexion-varus/valgus/neutral or (hyper)-extension-varus/valgus/neutral by observing articular depression area on CT/MRI. Fractures were subclassified into rotation-neutral, internal- or external-rotation according to the Gerdy-tibial-tuberosity-surgical-epicondylar-axis (GTT-SEA) angle. Soft-tissue injury was documented if MRI was performed.
Flexion-valgus was the most common injury-force mechanism (n = 85, 41.9%), followed by extension-valgus (n = 57, 28.1%). Other mechanisms were less common (9.4% extension-varus, 5.9% flexion-neutral, 4.9% flexion-varus, 3.9% hyperextension-valgus, 3.4% extension-neutral and 2.5% hyperextension-varus). The GTT-SEA angle could be measured in 194 (95.6%) of 203 classified patients, revealing internal rotation in 83 (42.8%) and external rotation in 53 (27.3%). No significant difference was found between injury-force mechanism type and axial rotation group (P = 0.964) or extent of rotation (H(8) = 7.116, P = 0.524). Only 41 (21.1%) of 194 fully classified fractures underwent MRI, all revealing soft-tissue injury to some extent. High-grade posterolateral injuries occurred mainly in rotated TPF.
Our results describe the common forms of axial rotation present in TPF and explore their association with injury-force mechanism and soft-tissue injury. Applying the injury-force mechanism patterns and addressing rotational forces could, together with preoperative MRI and intra-operative stability assessment, help determine the need to surgically address associated soft-tissue injury.
明确胫骨平台骨折（TPF）的损伤机制有助于确定植入物的类型和位置，以及可能受损的软组织。本研究旨在分析 TPF 中的损伤机制，包括轴向旋转。
对 3.5 年内就诊的 203 例骨折患者的损伤机制进行了分析。通过观察 CT/MRI 上的关节凹陷面积，将骨折分为屈曲内翻/外翻/中立位或（超）伸展内翻/外翻/中立位。根据 Gerdy 胫骨结节-外科-鹰嘴轴（GTT-SEA）角，将骨折分为旋转中立位、内旋或外旋。如果进行了 MRI，则记录软组织损伤情况。
最常见的损伤机制是屈曲外翻（n=85，41.9%），其次是伸展外翻（n=57，28.1%）。其他机制较少见（9.4%伸展内翻，5.9%屈曲中立位，4.9%屈曲内翻，3.9%过伸外翻，3.4%伸展中立位和 2.5%过伸内翻）。在 203 例分类患者中，有 194 例（95.6%）可测量 GTT-SEA 角，其中 83 例（42.8%）为内旋，53 例（27.3%）为外旋。损伤机制类型和轴向旋转组之间（P=0.964）或旋转程度之间（H（8）=7.116，P=0.524）无显著差异。仅 41 例（21.1%）完全分类的骨折患者接受了 MRI 检查，所有患者均显示出不同程度的软组织损伤。高等级后外侧损伤主要发生在外旋 TPF 中。
本研究描述了 TPF 中常见的轴向旋转形式，并探讨了其与损伤机制和软组织损伤的关系。应用损伤机制模式并解决旋转力，结合术前 MRI 和术中稳定性评估，有助于确定是否需要手术治疗相关的软组织损伤。
