Article
Tibia plateau fractures in winter sports. Fracture patterns and CT evaluation – Creation of a frequency map to determine location and degree of damage to the joint surface
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Authors
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Phillipp Gebel
- Spital Wallis, Visp, Switzerland
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Malte Tryzna
- Spital Wallis, Visp, Switzerland
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Drazen Sramek
- Spital Wallis, Visp, Switzerland
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Bernd Wildhelm
- Spital Wallis, Visp, Switzerland
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Thomas Beck
- Spital Wallis, Visp, Switzerland
| Published: | October 10, 2016 |
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Outline
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Objectives: Computed tomography (CT) is a useful modality in characterizing tibia plateau fractures. Fractures of the tibia plateau involve an unmatched set of considerations which must be understood to provide optimal treatment.
The purpose of this study was to create and evaluate a frequency map of tibia plateau fractures by CT in winter sports. We hypothesized that the frequency mapping shows aspects of involvement that do not fit to the classic classifications which could be important for clinical operative planning and clinical results.
Methods: 185 tibial plateau fractures between Jan. 2013- Dec. 2015 in winter sports were retrospectively included in this single center study. We created a frequency map onto an axial template of an intact subarticular tibial plateau. Therefore we separated the joint surface in 3 lateral, 3 medial and 3 tibial spine areas and counted the frequency of involvement. Furthermore we calculated the volume of impression and measured the distance of dislocation of the main fragments.
Results and Conclusion: This study included 104 female and 81 male patients (average age 53 years) with a tibia plateau fracture. 153 patients were skiers, 10 snowboarders and 32 other winter sports like sledding.
96 fractures were Schatzker type 1, 2 or 3; 37 were Schatzker type 4 and 27 were Schatzker type 5 or 6.
2 were orthopedic trauma association type A, 106 were type B and 55 were type C fractures.
Three major fracture areas were found: the lateral joint area , found in 45%; the combination of lateral, tibia spine and medial area, found in 23%; and the lateral in combination with tibial spine, found in 16%.
The tibial plateau fractures in this study show 3 major fracture characteristics in our frequency map (76%). Nevertheless there are many other combinations of fractures expressed in this frequency map. The complexity of the fractures concerning the joint surface is not sufficiantely covered in the common classifications.
Our frequency map offers a simple and useful addition to the common classification systems. For the preoperative planning and surgical strategy an understanding of these complex fractures is essential.
