Skip to main content
Erschienen in: Archives of Orthopaedic and Trauma Surgery 7/2013

01.07.2013 | Trauma Surgery

The incidence of posterior tibial plateau fracture: an investigation of 525 fractures by using a CT-based classification system

verfasst von: Guang Yang, Qilin Zhai, Yi Zhu, Hui Sun, Sven Putnis, Congfeng Luo

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 7/2013

Einloggen, um Zugang zu erhalten

Abstract

Background

Fractures of the tibial plateau are seen frequently in orthopedic trauma units and traditionally classified based on two-dimension plain radiographs with the Schatzker Classification system, the most popular. This system focuses on fractures involving the medial and lateral plateau but does not comment on fractures that involve the posterior aspect of the tibial plateau. The purpose of this study was to investigate the incidence of posterior tibial plateau fracture and propose a new computed tomography (CT)-based three-column classification system to guide fracture treatment.

Methods

Between January 2008 and December 2009, 525 tibial plateau fractures admitted to a level 1 trauma center were retrospectively analyzed by four orthopedic trauma surgeons. Antero-posterior plain radiographs were used for Schatzker classification. CT imaging was used to further classify the fracture types with axial views dividing the plateau into three columns: a lateral, medial, and posterior. Posterior tibial plateau fracture (PTPF) was defined as a fracture with an independent fragment of the posterior column

Results

PTPFs were found in 151 cases and had an incidence of 28.8 % in this studied population. Except for type III, PTPFs were observed in each type of the Schatzker classification system. The Schatzker type VI, V, and IV fractures had the three highest percentages of PTPFs, with 76.1, 51.2, and 22.4 %, respectively.

Conclusions

Fractures of the posterior tibial plateau are not uncommon, especially in high-energy trauma. CT imaging is required to appreciate these fracture patterns, and a three-column classification allows for a better understanding of the fracture morphology and the injury mechanism, which guides surgical management.
Literatur
1.
Zurück zum Zitat Barei DP, O’Mara TJ, Taitsman LA, Dunbar RP, Nork SE (2008) Frequency and fracture morphology of the posteromedial fragment in bicondylar tibial plateau fracture patterns. J Orthop Trauma 22(3):176–182PubMedCrossRef Barei DP, O’Mara TJ, Taitsman LA, Dunbar RP, Nork SE (2008) Frequency and fracture morphology of the posteromedial fragment in bicondylar tibial plateau fracture patterns. J Orthop Trauma 22(3):176–182PubMedCrossRef
2.
Zurück zum Zitat Berkson EM, Virkus WW (2006) High-energy tibial plateau fractures. J Am Acad Orthop Surg 14(1):20–31PubMed Berkson EM, Virkus WW (2006) High-energy tibial plateau fractures. J Am Acad Orthop Surg 14(1):20–31PubMed
3.
Zurück zum Zitat Bhattacharyya T, McCarty LP 3rd, Harris MB et al (2005) The posterior shearing tibial plateau fracture: treatment and results via a posterior approach. J Orthop Trauma 19(5):305–310PubMed Bhattacharyya T, McCarty LP 3rd, Harris MB et al (2005) The posterior shearing tibial plateau fracture: treatment and results via a posterior approach. J Orthop Trauma 19(5):305–310PubMed
4.
Zurück zum Zitat Brunner A, Honigmann P, Horisberger M, Babst R (2009) Open reduction and fixation of medial Moore type II fractures of the tibial plateau by a direct dorsal approach. Arch Orthop Trauma Surg 129(9):1233–1238PubMedCrossRef Brunner A, Honigmann P, Horisberger M, Babst R (2009) Open reduction and fixation of medial Moore type II fractures of the tibial plateau by a direct dorsal approach. Arch Orthop Trauma Surg 129(9):1233–1238PubMedCrossRef
5.
Zurück zum Zitat Chan PS, Klimkiewicz JJ, Luchetti WT et al (1997) Impact of CT scan on treatment plan and fracture classification of tibial plateau fractures. J Orthop Trauma 11(7):484–489PubMedCrossRef Chan PS, Klimkiewicz JJ, Luchetti WT et al (1997) Impact of CT scan on treatment plan and fracture classification of tibial plateau fractures. J Orthop Trauma 11(7):484–489PubMedCrossRef
6.
Zurück zum Zitat Fakler JK, Ryzewicz M, Hartshorn C, Morgan SJ, Stahel PF, Smith WR (2007) Optimizing the management of Moore type I postero-medial split fracture dislocations of the tibial head: description of the Lobenhoffer approach. J Orthop Trauma 21(5):330–336PubMedCrossRef Fakler JK, Ryzewicz M, Hartshorn C, Morgan SJ, Stahel PF, Smith WR (2007) Optimizing the management of Moore type I postero-medial split fracture dislocations of the tibial head: description of the Lobenhoffer approach. J Orthop Trauma 21(5):330–336PubMedCrossRef
7.
Zurück zum Zitat Gosling T, Schandelmaier P, Muller M, Hankemeier S, Wagner M, Krettek C (2005) Single lateral locked screw plating of bicondylar tibial plateau fractures. Clin Orthop Relat Res 439:207–214PubMedCrossRef Gosling T, Schandelmaier P, Muller M, Hankemeier S, Wagner M, Krettek C (2005) Single lateral locked screw plating of bicondylar tibial plateau fractures. Clin Orthop Relat Res 439:207–214PubMedCrossRef
8.
Zurück zum Zitat Higgins TF, Kemper D, Klatt J (2009) Incidence and morphology of the posteromedial fragment in bicondylar tibial plateau fractures. J Orthop Trauma 23(1):45–51PubMedCrossRef Higgins TF, Kemper D, Klatt J (2009) Incidence and morphology of the posteromedial fragment in bicondylar tibial plateau fractures. J Orthop Trauma 23(1):45–51PubMedCrossRef
9.
Zurück zum Zitat Lauge N (1948) Fractures of the ankle; analytic historic survey as the basis of new experimental, roentgenologic and clinical investigations. Arch Surg 56(3):259–317PubMedCrossRef Lauge N (1948) Fractures of the ankle; analytic historic survey as the basis of new experimental, roentgenologic and clinical investigations. Arch Surg 56(3):259–317PubMedCrossRef
10.
Zurück zum Zitat Lobenhoffer P, Gerich T, Bertram T, Lattermann C, Pohlemann T, Tscheme H (1997) Particular posteromedial and posterolateral approaches for the treatment of tibial head fractures. Unfallchirurg 100(12):957–967PubMedCrossRef Lobenhoffer P, Gerich T, Bertram T, Lattermann C, Pohlemann T, Tscheme H (1997) Particular posteromedial and posterolateral approaches for the treatment of tibial head fractures. Unfallchirurg 100(12):957–967PubMedCrossRef
11.
Zurück zum Zitat Luo CF, Jiang R, Hu CF, Zeng BF (2006) Medial double-plating for fracture dislocations involving the proximal tibia. Knee 13(5):389–394PubMedCrossRef Luo CF, Jiang R, Hu CF, Zeng BF (2006) Medial double-plating for fracture dislocations involving the proximal tibia. Knee 13(5):389–394PubMedCrossRef
12.
Zurück zum Zitat Luo CF, Sun H, Zhang B, Zeng BF (2010) Three-column fixation for complex tibial plateau fractures. J Orthop Trauma 24(11):683–692PubMedCrossRef Luo CF, Sun H, Zhang B, Zeng BF (2010) Three-column fixation for complex tibial plateau fractures. J Orthop Trauma 24(11):683–692PubMedCrossRef
13.
Zurück zum Zitat Sanders R (2000) Displaced intra-articular fractures of the calcaneus. J Bone Joint Surg Am 82(2):225–250PubMed Sanders R (2000) Displaced intra-articular fractures of the calcaneus. J Bone Joint Surg Am 82(2):225–250PubMed
14.
Zurück zum Zitat Solomon LB, Stevenson AW, Baird RP, Pohl AP (2010) Posterolateral transfibular approach to tibial plateau fractures: technique, results, and rationale. J Orthop Trauma 24(8):505–514PubMedCrossRef Solomon LB, Stevenson AW, Baird RP, Pohl AP (2010) Posterolateral transfibular approach to tibial plateau fractures: technique, results, and rationale. J Orthop Trauma 24(8):505–514PubMedCrossRef
15.
Zurück zum Zitat Stahel PF, Smith WR, Morgan SJ (2008) Posteromedial fracture fragments of the tibial plateau: an unsolved problem? J Orthop Trauma 22(7):504 Author reply 504–505PubMedCrossRef Stahel PF, Smith WR, Morgan SJ (2008) Posteromedial fracture fragments of the tibial plateau: an unsolved problem? J Orthop Trauma 22(7):504 Author reply 504–505PubMedCrossRef
16.
Zurück zum Zitat Tao J, Hang DH, Wang QG et al (2008) The posterolateral shearing tibial plateau fracture: treatment and results via a modified posterolateral approach. Knee 15(6):473–479PubMedCrossRef Tao J, Hang DH, Wang QG et al (2008) The posterolateral shearing tibial plateau fracture: treatment and results via a modified posterolateral approach. Knee 15(6):473–479PubMedCrossRef
17.
Zurück zum Zitat Thomas C, Athanasiov A, Wullschleger M, Schuetz M (2009) Current concepts in tibial plateau fractures. Acta Chir Orthop Traumatol Cech 76(5):363–373PubMed Thomas C, Athanasiov A, Wullschleger M, Schuetz M (2009) Current concepts in tibial plateau fractures. Acta Chir Orthop Traumatol Cech 76(5):363–373PubMed
18.
Zurück zum Zitat Tscherne H, Lobenhoffer P (1993) Tibial plateau fractures. Management and expected results. Clin Orthop Relat Res 292:87–100PubMed Tscherne H, Lobenhoffer P (1993) Tibial plateau fractures. Management and expected results. Clin Orthop Relat Res 292:87–100PubMed
19.
Zurück zum Zitat Waldrop JI, Macey TI, Trettin JC, Bourgeois WR, Hughston JC (1988) Fractures of the posterolateral tibial plateau. Am J Sports Med 16(5):492–498PubMedCrossRef Waldrop JI, Macey TI, Trettin JC, Bourgeois WR, Hughston JC (1988) Fractures of the posterolateral tibial plateau. Am J Sports Med 16(5):492–498PubMedCrossRef
20.
Zurück zum Zitat Wicky S, Blaser PF, Blanc CH, Leyvraz PF, Schnyder P, Meuli RA (2000) Comparison between standard radiography and spiral CT with 3D reconstruction in the evaluation, classification and management of tibial plateau fractures. Eur Radiol 10(8):1227–1232PubMedCrossRef Wicky S, Blaser PF, Blanc CH, Leyvraz PF, Schnyder P, Meuli RA (2000) Comparison between standard radiography and spiral CT with 3D reconstruction in the evaluation, classification and management of tibial plateau fractures. Eur Radiol 10(8):1227–1232PubMedCrossRef
21.
Zurück zum Zitat Yang G, Zhu Y, Luo C, Putnis S (2012) Morphological characteristics of Schatzker type IV tibial plateau fractures: a computer tomography based study. Int Orthop 36(11):2355–2360PubMedCrossRef Yang G, Zhu Y, Luo C, Putnis S (2012) Morphological characteristics of Schatzker type IV tibial plateau fractures: a computer tomography based study. Int Orthop 36(11):2355–2360PubMedCrossRef
22.
Zurück zum Zitat Yu GR, Xia J, Zhou JQ, Yang YF (2012) Low-energy fracture of posterolateral tibial plateau: treatment by a posterolateral prone approach. J Trauma Acute Care Surg 72(5):1416–1423PubMed Yu GR, Xia J, Zhou JQ, Yang YF (2012) Low-energy fracture of posterolateral tibial plateau: treatment by a posterolateral prone approach. J Trauma Acute Care Surg 72(5):1416–1423PubMed
23.
Zurück zum Zitat Zeng ZM, Luo CF, Putnis S, Zeng BF (2011) Biomechanical analysis of posteromedial tibial plateau split fracture fixation. Knee 18(1):51–54PubMedCrossRef Zeng ZM, Luo CF, Putnis S, Zeng BF (2011) Biomechanical analysis of posteromedial tibial plateau split fracture fixation. Knee 18(1):51–54PubMedCrossRef
24.
Zurück zum Zitat Zhang W, Luo CF, Putnis S, Sun H, Zeng ZM, Zeng BF (2011) Biomechanical analysis of four different fixations for the posterolateral shearing tibial plateau fracture. Knee 19(2):94–98PubMedCrossRef Zhang W, Luo CF, Putnis S, Sun H, Zeng ZM, Zeng BF (2011) Biomechanical analysis of four different fixations for the posterolateral shearing tibial plateau fracture. Knee 19(2):94–98PubMedCrossRef
Metadaten
Titel
The incidence of posterior tibial plateau fracture: an investigation of 525 fractures by using a CT-based classification system
verfasst von
Guang Yang
Qilin Zhai
Yi Zhu
Hui Sun
Sven Putnis
Congfeng Luo
Publikationsdatum
01.07.2013
Verlag
Springer-Verlag
Erschienen in
Archives of Orthopaedic and Trauma Surgery / Ausgabe 7/2013
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-013-1735-4

Weitere Artikel der Ausgabe 7/2013

Archives of Orthopaedic and Trauma Surgery 7/2013 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.