Monir Mohammad, Elkohail Ahmed, Elbanna Mohamed, Soffar Ali, Al-Feeshawy Ahmed
Orthopaedics and Trauma, General Organization For Teaching Hospitals and Institutes, Cairo, EGY.
Orthopaedics and Trauma, Princess Royal University Hospital, King's College Hospital NHS Foundation Trust, London, GBR.
Cureus. 2025 Aug 27;17(8):e91099. doi: 10.7759/cureus.91099. eCollection 2025 Aug.
Tibial plateau fractures present significant challenges, especially when joint depression is accompanied by metaphyseal comminution. The primary objective in these fractures is to attain, if feasible, an anatomic reduction of the articular surface, thereby restoring joint congruity and mechanical alignment to enhance functional outcomes and decrease the incidence of post-traumatic arthritis. Fractures with significant depression of the articular surface necessitate the elevation of the depressed fragments and stable internal fixation.
This study aimed to assess prospectively postoperative articular congruity and determine the articular surface collapse following open reduction and restoration of depressed tibial plateau fractures. The analysis of results was made in terms of age of patients, sex distribution, type of fracture, and special habits. The second objective of the study was to evaluate the surgical and patient-related factors associated with this drawback. The data were analyzed to detect any statistically significant correlation between these parameters and clinical and radiographic outcomes using Rasmussen's clinical and radiological grading systems in a six-month follow-up.
Patients with tibial plateau fractures were selected based on inclusion and exclusion criteria, and these fractures were categorized according to the Schatzker classification based on post-traumatic anteroposterior and lateral X-ray films. In addition to that, all patients had preoperative CT scans of the injured knee. The sample size consisted of 40 cases with a history of proximal leg or knee trauma. All cases underwent open reduction and restoration of the articular surface. Depression of the joint surface was elevated under visual control; a buttress plate and screws were used for internal fixation. For inclusion in the present analysis, two conditions had to be satisfied: adequate reduction with plate fixation and a follow-up period of at least six months. Radiological follow-up included an early postoperative X-ray and CT scan, serial follow-up X-rays, and an X-ray and CT scan at six months.
Fourteen (35%) patients assessed experienced postoperative articular surface collapse during the follow-up evaluation. A statistically significant association was found between postoperative articular surface collapse and the following variables: age, preoperative articular surface fragmentation, use of bone graft, smoking, and early weight-bearing. Collapse correlated strongly with clinical outcomes, including significant knee pain (p<0.001) and reduced walking capacity. The presence of collapse also adversely affected the radiographic scores at follow-up (p < 0.001).
胫骨平台骨折带来了重大挑战，尤其是当关节面塌陷伴有干骺端粉碎时。这些骨折的主要目标是在可行的情况下实现关节面的解剖复位，从而恢复关节的一致性和力学对线，以改善功能结果并降低创伤后关节炎的发生率。关节面严重塌陷的骨折需要抬起塌陷的骨块并进行稳定的内固定。
本研究旨在前瞻性评估切开复位并恢复塌陷胫骨平台骨折后的术后关节一致性，并确定关节面塌陷情况。根据患者年龄、性别分布、骨折类型和特殊习惯对结果进行分析。本研究的第二个目的是评估与这一缺陷相关的手术和患者相关因素。在六个月的随访中，使用拉斯穆森临床和放射学分级系统对数据进行分析，以检测这些参数与临床和影像学结果之间是否存在任何统计学上的显著相关性。
根据纳入和排除标准选择胫骨平台骨折患者，并根据创伤后前后位和侧位X线片，按照沙茨克分类法对这些骨折进行分类。此外，所有患者均对受伤膝关节进行了术前CT扫描。样本量包括40例有近端腿部或膝关节创伤史的病例。所有病例均接受了切开复位和关节面恢复手术。在直视下抬起关节面的塌陷部分；使用支撑钢板和螺钉进行内固定。纳入本分析需满足两个条件：钢板固定后复位良好且随访期至少六个月。放射学随访包括术后早期X线和CT扫描、系列随访X线以及六个月时的X线和CT扫描。
在随访评估中，14例（35%）患者出现了术后关节面塌陷。术后关节面塌陷与以下变量之间存在统计学上的显著关联：年龄、术前关节面碎裂、使用骨移植、吸烟和早期负重。塌陷与临床结果密切相关，包括严重的膝关节疼痛（p<0.001）和步行能力下降。塌陷的存在也对随访时的放射学评分产生了不利影响（p<0.001）。
