Postoperative Computed Tomography Evaluation of Posterior Tibial Plateau Fractures: Mean 7-Year Clinical Follow-Up

Abstract

The aim is to assess the association between computed tomography (CT) findings and clinical outcomes in posterior tibial plateau fractures (TPF). This is a retrospective analysis of the records of 23 patients with posterior TPF treated at our institution between 2004 and 2011. Two indices of residual articular displacement of posterior TPF (gap and step-off) were measured from CT images, and clinical outcomes were assessed using the Short Musculoskeletal Function Assessment (SMFA) questionnaire. Spearman's rank correlation coefficient analysis was used to evaluate the correlations between the postoperative posterior TPF radiological findings and the clinical outcomes. Both the intraobserver and the interobserver correlation coefficients were high (0.90 and 0.92, respectively), indicating excellent agreement between the reviewers for the assessment of residual displacement via CT scans. Additionally, residual articular step displacement showed a strongly negative correlation with clinical outcomes (R = 0.700, p = 0.036), whereas the residual gap displacement did not (R = 0.400, p = 0.505). More importantly, the medial posterior step displacement was significantly correlated with the clinical outcomes (p = 0.040), whereas the lateral posterior step displacement was not (p = 0.618). Based on the data of this study, the higher the step-off deformity of the medial posterior tibial plateau, the worse the SMFA. More attention should be paid to this factor when treating medial posterior TPF.

Keywords

tibial plateau fracture - clinical outcomes - computed tomography

Note

Our study was approved by the Clinical Trials and Ethics Committee of the hospital and was conducted in accordance with the Declaration of Helsinki, and informed consent was obtained from the patients or their relatives.

• References

• 1 Moore TM, Patzakis MJ, Harvey JP. Tibial plateau fractures: definition, demographics, treatment rationale, and long-term results of closed traction management or operative reduction. J Orthop Trauma 1987; 1 (02) 97-119
• 2 Adams Jr JD, Della Rocca GJ. Management of posterior articular depression in tibial plateau fractures. J Knee Surg 2016; 29 (01) 28-33
• 3 Yang G, Zhai Q, Zhu Y, Sun H, Putnis S, Luo C. The incidence of posterior tibial plateau fracture: an investigation of 525 fractures by using a CT-based classification system. Arch Orthop Trauma Surg 2013; 133 (07) 929-934
• 4 Carlson DA. Posterior bicondylar tibial plateau fractures. J Orthop Trauma 2005; 19 (02) 73-78
• 5 Bhattacharyya T, McCarty III LP, Harris MB. , et al. The posterior shearing tibial plateau fracture: treatment and results via a posterior approach. J Orthop Trauma 2005; 19 (05) 305-310
• 6 Chang S-M, Zheng H-P, Li H-F. , et al. Treatment of isolated posterior coronal fracture of the lateral tibial plateau through posterolateral approach for direct exposure and buttress plate fixation. Arch Orthop Trauma Surg 2009; 129 (07) 955-962
• 7 Jiwanlal A, Jeray KJ. Outcome of posterior tibial plateau fixation. J Knee Surg 2016; 29 (01) 34-39
• 8 Engelberg R, Martin DP, Agel J, Obremsky W, Coronado G, Swiontkowski MF. Musculoskeletal Function Assessment instrument: criterion and construct validity. J Orthop Res 1996; 14 (02) 182-192
• 9 Martin DP, Engelberg R, Agel J, Snapp D, Swiontkowski MF. Development of a musculoskeletal extremity health status instrument: the Musculoskeletal Function Assessment instrument. J Orthop Res 1996; 14 (02) 173-181
• 10 Agel J, Obremsky W, Kregor P. , et al. Administration of the Short Musculoskeletal Function Assessment: impact on office routine and physician-patient interaction. Orthopedics 2003; 26 (08) 783-788
• 11 Marsh JL, Slongo TF, Agel J. , et al. Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 2007; 21 (10, Suppl): S1-S133
• 12 Cole RJ, Bindra RR, Evanoff BA, Gilula LA, Yamaguchi K, Gelberman RH. Radiographic evaluation of osseous displacement following intra-articular fractures of the distal radius: reliability of plain radiography versus computed tomography. J Hand Surg Am 1997; 22 (05) 792-800
• 13 Domholdt EM. Physical Therapy Research: Principles and Applications. Philadelphia, PA: Saunders; 2000: 300-324
• 14 Weil YA, Gardner MJ, Boraiah S, Helfet DL, Lorich DG. Posteromedial supine approach for reduction and fixation of medial and bicondylar tibial plateau fractures. J Orthop Trauma 2008; 22 (05) 357-362
• 15 Kubiak EN, Camuso MR, Barei DP, Nork SE. Operative treatment of ipsilateral noncontiguous unicondylar tibial plateau and shaft fractures: combining plates and nails. J Orthop Trauma 2008; 22 (08) 560-565
• 16 Eggli S, Hartel MJ, Kohl S, Haupt U, Exadaktylos AK, Röder C. Unstable bicondylar tibial plateau fractures: a clinical investigation. J Orthop Trauma 2008; 22 (10) 673-679
• 17 Hackl W, Riedl J, Reichkendler M, Benedetto KP, Freund M, Bale R. [Preoperative computerized tomography diagnosis of fractures of the tibial plateau]. Unfallchirurg 2001; 104 (06) 519-523
• 18 Brunner A, Horisberger M, Ulmar B, Hoffmann A, Babst R. Classification systems for tibial plateau fractures; does computed tomography scanning improve their reliability?. Injury 2010; 41 (02) 173-178
• 19 Catalano III LW, Barron OA, Glickel SZ. Assessment of articular displacement of distal radius fractures. Clin Orthop Relat Res 2004; (423) 79-84
• 20 Weigel DP, Marsh JL. High-energy fractures of the tibial plateau. Knee function after longer follow-up. J Bone Joint Surg Am 2002; 84-A [phone]
• 21 Coventry MB. Proximal tibial osteotomy. Orthop Rev 1988; 17 (05) 456-458
• 22 Dingwall IM. Biomechanics of the knee. In: Barrett D. , ed. Essential Basic Sciences for Orthopedics. Oxford: Butterworth-Heinemann; 1994: 94-108
• 23 Hsu RW, Himeno S, Coventry MB, Chao EY. Normal axial alignment of the lower extremity and load-bearing distribution at the knee. Clin Orthop Relat Res 1990; (255) 215-227
• 24 Wu CC, Tai CL. Plating treatment for tibial plateau fractures: a biomechanical comparison of buttress and tension band positions. Arch Orthop Trauma Surg 2007; 127 (01) 19-24
• 25 Honkonen SE. Indications for surgical treatment of tibial condyle fractures. Clin Orthop Relat Res 1994; (302) 199-205