Department of Orthopedics, The Second Affiliated Hospital of Soochow University, No.1055, SanXiang Road, Gusu District, Suzhou, Jiangsu Province, 215004, PR China.
Department of Orthopedics, The Second Affiliated Hospital of Soochow University, No.1055, SanXiang Road, Gusu District, Suzhou, Jiangsu Province, 215004, PR China.
Injury. 2024 Dec;55(12):111921. doi: 10.1016/j.injury.2024.111921. Epub 2024 Oct 24.
Current literature offers scant insights into Schatzker IV tibial plateau fractures (TPFs) that affect the posterolateral (PL) column. This study seeks to elucidate the prevalence of meniscal and ligamentous injuries in the knee, as well as the clinical outcomes, in Schatzker IV TPF cases, both with and without PL column involvement.
We conducted a retrospective analysis of clinical and imaging data from patients with Schatzker IV TPFs who received surgical treatment at our institution between January 2018 and January 2022. Patient demographics and surgical details were meticulously documented. The study participants were categorized into two groups based on the involvement of the PL column in the Schatzker IV TPF. Group A comprised patients without PL column fractures, whereas Group B included those with such fractures. We compared soft tissue injuries affecting knee stability, namely meniscal and ligamentous injuries, between two groups using Magnetic Resonance Imaging (MRI) and surgical records. Further, Group B was divided into subgroups based on the presence or absence of knee subluxation. Within Group B, we measured the lateral plateau depression (LPD) and lateral plateau widening (LPW). Additionally, we investigated the frequency of meniscus entrapment in patients with PL column fractures. Clinical outcomes were assessed using The American Hospital for Special Surgery (HSS) and Rasmussen scores.
The study comprised 66 patients with Schatzker IV TPFs. Of these, 12 patients had no PL column fracture, while 54 had a PL column fracture. Group B demonstrated a 57.4 % and 64.8 % incidence of lateral meniscus (LM) and anterior cruciate ligament (ACL) injuries, respectively, significantly higher than that in Group A (25 %, 8.3 %) (p = 0.044, p < 0.001). Within Group B, those with knee subluxation showed a marked increase in LPD (14.5 ± 5.3 mm) and LPW (9.3 ± 4.9 mm), correlating with a higher rate of meniscus entrapment (76.0 %) (p < 0.001). Patients in Group B had lower HSS and Rasmussen scores compared to Group A (p = 0.048, p = 0.006).
This investigation reveals that Schatzker IV TPFs involving the PL column are highly associated with increased rates of LM and ACL injuries. Additionally, these fractures correlate with a greater likelihood of knee subluxation and meniscus entrapment, ultimately leading to poorer prognostic outcomes.
目前的文献对影响后外侧（PL）柱的 Schatzker IV 胫骨平台骨折（TPF）提供的见解甚少。本研究旨在阐明 Schatzker IV TPF 患者的半月板和韧带损伤的发生率以及膝关节的临床结果，包括有无 PL 柱受累的病例。
我们对 2018 年 1 月至 2022 年 1 月在我院接受手术治疗的 Schatzker IV TPF 患者的临床和影像学资料进行了回顾性分析。详细记录了患者的人口统计学和手术细节。根据 Schatzker IV TPF 中 PL 柱的受累情况，将研究参与者分为两组。A 组患者无 PL 柱骨折，B 组患者有 PL 柱骨折。我们使用磁共振成像（MRI）和手术记录比较两组影响膝关节稳定性的软组织损伤，即半月板和韧带损伤。进一步，根据是否存在膝关节半脱位将 B 组分为亚组。在 B 组中，我们测量了外侧平台凹陷（LPD）和外侧平台增宽（LPW）。此外，我们还研究了 PL 柱骨折患者的半月板嵌顿发生率。使用美国特种外科医院（HSS）和 Rasmussen 评分评估临床结果。
本研究共纳入 66 例 Schatzker IV TPF 患者。其中，12 例患者无 PL 柱骨折，54 例患者有 PL 柱骨折。B 组外侧半月板（LM）和前交叉韧带（ACL）损伤的发生率分别为 57.4%和 64.8%，显著高于 A 组（25%，8.3%）（p=0.044，p<0.001）。在 B 组中，有膝关节半脱位的患者 LPD（14.5±5.3mm）和 LPW（9.3±4.9mm）明显增加，与半月板嵌顿发生率较高（76.0%）相关（p<0.001）。与 A 组相比，B 组患者的 HSS 和 Rasmussen 评分较低（p=0.048，p=0.006）。
本研究表明，涉及 PL 柱的 Schatzker IV TPF 与 LM 和 ACL 损伤发生率增高密切相关。此外，这些骨折与膝关节半脱位和半月板嵌顿的可能性增加相关，最终导致预后较差。
