Flexion-valgus unicondylar tibial plateau depression fracture pattern: Classification and treatment |
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| Institution: | 1. Department of Orthopaedic Surgery, The Alfred Hospital, Australia;2. Emergency & Trauma Centre, The Alfred Hospital, Australia;3. Department of Epidemiology & Preventive Medicine, Monash University, Australia;4. National Trauma Research Institute, The Alfred Hospital, Australia;1. Department of Surgery and Perioperative Care, Dell Medical School, Health Discovery Building 6.706, 1701 Trinity St., Austin, TX 78723, USA;2. Department of General Surgery, OLVG, Oosterpark 9, 1091 AC Amsterdam, The Netherlands;3. Department of Orthopaedic Surgery, JPS Health Network, 1500 S. Main St, Fort Worth, TX 76104, USA;4. Department of Orthopaedic Surgery, Acclaim Physician Group, Ben Hogan Center, 800 5th Ave, Suite 400, Fort Worth, TX 76104, USA;1. Brabant Trauma Registry, Network Emergency Care Brabant, The Netherlands;2. Department of Surgery, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands;1. Department of Orthopaedic and Trauma Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia, Flinders University and University of Amsterdam (PhD Candidate) Adelaide, South Australia and Amsterdam, The Netherlands, University of Adelaide (Masters Candidate), Adelaide, South Australia;2. University of Amsterdam, Department of Orthopaedic Surgery, Academisch Medisch Centrum, Amsterdam, The Netherlands, Department of Orthopaedics and Trauma Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia;3. Department of Orthopaedic Surgery, Rijnstate Hospital, Arnhem, The Netherlands;4. Adelaide University, Adelaide, South Australia, Australia;5. Department of Orthopaedics and Trauma Surgery, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia;6. Department of Orthopaedics and Trauma Surgery, Flinders Medical Centre and Flinders University, Adelaide, South Australia, Australia |
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| Abstract: | PurposeThe authors have identified a subset of unicondylar tibial plateau depression fracture patterns caused by a flexion-valgus force. The purpose of this study was to describe this fracture pattern and suggest a modified lateral approach that may allow for improved reduction and stabilization.MethodsThe preoperative radiographs and CT scans of 102 patients who sustained unicondylar tibial plateau fractures (OTA 41B) were reviewed. Twenty-six fracture patients had posterolateral (PL) tibial plateau depression fractures. By medical record review and telephone follow-up, the injury mechanism of the 22 unicondylar tibial plateau fractures was confirmed as a flexion-valgus force. The radiographic features of those cases were analyzed and measured. To address this specific fracture pattern, a modified approach combined with a novel intra-articular osteotomy was applied.ResultsAccording to the morphological characteristics, this tibial plateau fracture pattern could be divided into two subtypes: type A was a confined, basin-like articular surface depression fracture located in the PL quadrant, and type B was a cancellous fracture involving the PL tibial plateau resulting in a decrease in the posterior slope. One radiographic hallmark of this fracture pattern is an anatomically or a mechanically intact posterior column wall. The novel approach was applied to both types. The postoperative radiographic measurements revealed excellent reduction quality. On axial scans, the distance between the most posterior rafting screw and the tangent line of the tibial plateau rim was 3.0 ± 2.07 mm (from −1.9 to 4.3), and the angulation between them was 8.9 ± 3.02° (from −7.3 to 15.6). These results indicated excellent PL quadrant coverage from the rafting screws.ConclusionFlexion-valgus force-induced unicondylar tibial plateau depression fracture is a unique injury pattern. We suggest a novel surgical approach to address this injury’s key features, which may facilitate exposure and enhance fixation strength. |
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| Keywords: | Tibial plateau Flexion Valgus Approach |
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