Analysis of Risk Factors for the Posterolateral Articular Depression and Status of Posterolateral Fragment in Lateral Condylar and Bicondylar Tibial Plateau Fractures with Joint Depression

Jung-Yun Choi; Yong-Woon Shin; Beom-Jung Lee

doi:10.12671/jkfs.2013.26.4.241

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Choi, Shin, and Lee: Analysis of Risk Factors for the Posterolateral Articular Depression and Status of Posterolateral Fragment in Lateral Condylar and Bicondylar Tibial Plateau Fractures with Joint Depression

Original Article

Journal of the Korean Fracture Society 2013; 26(4): 241-247.

Published online: 18 October 2013

DOI: https://doi.org/10.12671/jkfs.2013.26.4.241

Analysis of Risk Factors for the Posterolateral Articular Depression and Status of Posterolateral Fragment in Lateral Condylar and Bicondylar Tibial Plateau Fractures with Joint Depression

Jung-Yun Choi, M.D., Yong-Woon Shin, M.D., Beom-Jung Lee, M.D.

Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, Seoul, Korea.

Address reprint requests to: Yong-Woon Shin, M.D. Department of Orthopedic Surgery, Inje University Sanggye Paik Hospital, 1342 Dongil-ro, Nowon-gu, Seoul 139-707, Korea. Tel: 82-2-950-1032, Fax: 82-2-934-6342, woonysos@paik.ac.kr

Received 24 April 2013 Revised 11 June 2013 Accepted 27 July 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate risk factors of posterolateral articular depression and characteristics of the posterolateral fragment in lateral condylar and bicondylar tibial plateau fractures with joint depression.

Materials and Methods

We reviewed 48 patients of Schatzker type II and type V (type II 34, type V 14) and evaluated risk factors of posterolateral articular depression according to the posterolateral fragment, fibular fracture, and Schatzker classification. We evaluated the position of articular depression and anterolateral fracture line of the posterolateral fragment and measured anterior to posterior lengths of the posterolateral fragment.

Results

Posterolateral articular depression was found in 20 of 34 cases (59%) with coexisting posterolateral fragment and in 16 of 21 cases (76%) with coexisting fibular fracture. There was a significant difference in the occurrence of posterolateral articular depression with the existence of the posterolateral fragment and fibular fracture (p<0.001). Multivariate regression analysis revealed that fibular fracture increased the occurrence of posterolateral articular depression (odds ratio 24.5, 95% confidence interval 2.2-267.2). Fifty-seven percentage of the anterolateral fracture line of the posterolateral fragment existed posterior to the anterior margin of the fibular head.

Conclusion

This study showed that fibular fracture affects posterolateral articular depression in Schatzker type II and V tibial plateau fractures. Selecting a fixation device and performing fracture reduction requires a careful consideration since the anterolateral fracture line of the posterolateral fragment exists posterior to the anterior margin of the fibular head.

Keywords: Tibial plateau fracture, Fibular fracture, Posterolateral fragment, Schatzker classification

Figures and Tables

Fig. 1

Three demensional computed tomographys show the position of articular depression center in tibial plateau fractures. A line is the connecting line between the medial and lateral posterior cortex of the tibial plateau. B line is the parallel line to A line that crossing the anterior border of the lateral tibial condyle. C line is the bisecting line between lines A and B, which divide anterior and posterior depression. The position of joint depression is marked with an asterisk.

(A) Anterior depression of tibial plateau fracture.

(B) Posterior depression of tibial plateau fracture.

Fig. 2

Photograph shows the anterior-posterior length of the posterolateral fragment with three dimensional computed tomography. A: lateral collateral ligament, B: biceps femoris muscle, C: distance between the posterior margin of the posterior condyle and the anterior margin of the posterolateral fragment, D: distance between the anterior margin of the fibular head and the anterior margin of the posterolateral fragment.

Table 1

Analysis of Posterolateral Depression of Tibial Plateau according to Posterolateral Fragment, Fibular Fracture, Schatzker Type, Age, and Gender Differences

Values are presented as number (%) or mean±standard deviation. p-value using Fisher's exact test. M/F: Male/female. ^*Significant at p<0.05.

Table 2

Multivariate Logistic Regression Analysis of Risk Factors for Posterolateral Articular Depression after Tibial Plateau Fractures

^*Significant at p<0.05. ^†Factors were selected by stepwise method.

Table 3

The Occurrence of Fibular Fracture according to Posterolateral Articular Depression of Tibial Plateau, Posterolateral Fragment, and Schatzker Types

Values are presented as number (%). p-value using Fisher's exact test. ^*Significant at p<0.05.

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