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J Knee Surg 2010; 23(4): 187-192
DOI: 10.1055/s-0030-1268694
ORIGINAL ARTICLE

© Thieme Medical Publishers

Soft Tissue Injury of the Knee after Tibial Plateau Fractures

James P. Stannard1 , Robert Lopez2 , David Volgas2
  • 1Department of Orthopaedic Surgery, University of Missouri Hospital, Columbia, Missouri
  • 2Department of Orthopaedic Surgery, University of Alabama, Birmingham, Alabama
Further Information

Publication History

Publication Date:
06 December 2010 (online)

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ABSTRACT

The purpose of this study was to document the pattern of ligament and meniscal injuries that occur during high-energy tibial plateau fractures. One hundred three patients with fractures due to high-energy mechanisms were evaluated with knee magnetic resonance imaging (MRI). All studies were read by a single musculoskeletal radiologist who was blinded to surgical and physical exam findings. Pertinent demographic information was obtained. There were 66 patients with AO/OTA type 41C fractures and 37 patients with AO/OTA type 41B fractures. Seventy-three (71%) patients tore at least one major ligament group, and 55 (53%) patients tore multiple ligaments. There were 53 torn ligaments in AO/OTA type 41C fractures (80%) compared with 20 torn ligaments in AO/OTA type 41B fractures (54%) (p < 0.001, Fisher's exact test). Using Schatzker's classification, we found the following correlation: type I, 13 fractures with 6 ligaments (46%); type II, 11 fractures with 5 ligaments (45%); type IV, 13 fractures with 9 ligaments (69%); type V, 13 fractures with 11 ligaments (85%); and type VI, 53 fractures with 42 ligaments (79%). A significant difference exists between the groups regarding the incidence of ligament injuries (p < 0.05) and also regarding high-energy (type IV, V, VI) versus low-energy (type I, II, III) fracture patterns. The incidence of knee dislocation was 32% for AO/OTA type 41B fractures and 23% for AO/OTA type 41C fractures. Knee dislocations (dislocated on presentation, bicruciate injury, or at least three ligament groups torn with a dislocatable knee) were most common in Schatzker type IV fractures (46%). Fifty patients sustained meniscus tears (49%), with 25 medial menisci and 35 lateral menisci injuries. Tibial plateau fractures frequently have important soft tissue injuries that are difficult to diagnose on physical examination. High-energy fracture patterns (AO/OTA type 41C or Schatzker type IV, V, VI) clearly have a significantly higher incidence of ligament injury, and these patients should be carefully evaluated to rule out a spontaneously reduced knee dislocation. We believe MRI scanning should be considered for tibial plateau fractures due to high-energy mechanism, allowing identification and treatment of associated soft tissue injuries.

KEYWORDS

Knee soft tissue injury - high-energy tibial plateau fracture

REFERENCES

  • 1 Ali A M, Burton M, Hashmi M, Saleh M. Outcome of complex fractures of the tibial plateau treated with a beam-loading ring fixation system.  J Bone Joint Surg Br. 2003;  85 691-699
    PubMedGoogle Scholar
  • 2 Ali A M, Burton M, Hashmi M, Saleh M. Treatment of displaced bicondylar tibial plateau fractures (OTA-41C2&3) in patients older than 60 years of age.  J Orthop Trauma. 2003;  17 346-352
    CrossrefPubMedGoogle Scholar
  • 3 Blokker C P, Rorabeck C H, Bourne R B. Tibial plateau fractures. An analysis of the results of treatment in 60 patients.  Clin Orthop Relat Res. 1984;  182 193-199
    PubMedGoogle Scholar
  • 4 Duwelius P J, Rangitsch M R, Colville M R, Woll T S. Treatment of tibial plateau fractures by limited internal fixation.  Clin Orthop Relat Res. 1997;  339 47-57
    CrossrefPubMedGoogle Scholar
  • 5 Gaudinez R F, Mallik A R, Szporn M. Hybrid external fixation of comminuted tibial plateau fractures.  Clin Orthop Relat Res. 1996;  328 203-210
    CrossrefPubMedGoogle Scholar
  • 6 Honkonen S E. Indications for surgical treatment of tibial condyle fractures.  Clin Orthop Relat Res. 1994;  302 199-205
    PubMedGoogle Scholar
  • 7 Lachiewicz P F, Funcik T. Factors influencing the results of open reduction and internal fixation of tibial plateau fractures.  Clin Orthop Relat Res. 1990;  259 210-215
    PubMedGoogle Scholar
  • 8 Mallik A R, Covall D J, Whitelaw G P. Internal versus external fixation of bicondylar tibial plateau fractures.  Orthop Rev. 1992;  21 1433-1436
    PubMedGoogle Scholar
  • 9 Marsh J L, Smith S T, Do T T. External fixation and limited internal fixation for complex fractures of the tibial plateau.  J Bone Joint Surg Am. 1995;  77 661-673
    PubMedGoogle Scholar
  • 10 Watson J T. High-energy fractures of the tibial plateau.  Orthop Clin North Am. 1994;  25 723-752
    PubMedGoogle Scholar
  • 11 Burri C, Bartzke G, Coldewey J, Muggler E. Fractures of the tibial plateau.  Clin Orthop Relat Res. 1979;  138 84-93
    PubMedGoogle Scholar
  • 12 Bennett W F, Browner B. Tibial plateau fractures: a study of associated soft tissue injuries.  J Orthop Trauma. 1994;  8 183-188
    CrossrefPubMedGoogle Scholar
  • 13 Dendrinos G K, Kontos S, Katsenis D, Dalas A. Treatment of high-energy tibial plateau fractures by the Ilizarov circular fixator.  J Bone Joint Surg Br. 1996;  78 710-717
    PubMedGoogle Scholar
  • 14 Fernandez D L. Anterior approach to the knee with osteotomy of the tibial tubercle for bicondylar tibial fractures.  J Bone Joint Surg Am. 1988;  70 208-219
    PubMedGoogle Scholar
  • 15 Hung S S, Chao E-K, Chan Y-S et al.. Arthroscopically assisted osteosynthesis for tibial plateau fractures.  J Trauma. 2003;  54 356-363
    CrossrefPubMedGoogle Scholar
  • 16 Moore T M. Fracture—dislocation of the knee.  Clin Orthop Relat Res. 1981;  156 128-140
    PubMedGoogle Scholar
  • 17 Stannard J P, Wilson T C, Volgas D A, Alonso J E. The less invasive stabilization system in the treatment of complex fractures of the tibial plateau: short-term results.  J Orthop Trauma. 2004;  18 552-558
    CrossrefPubMedGoogle Scholar
  • 18 Stannard J P, Wilson T C, Volgas D A, Alonso J E. Fracture stabilization of proximal tibial fractures with the proximal tibial LISS: early experience in Birmingham, Alabama (USA).  Injury. 2003;  34 (Suppl 1) A36-A42
    CrossrefPubMedGoogle Scholar
  • 19 Stokel E A, Sadasivan K K. Tibial plateau fractures: standardized evaluation of operative results.  Orthopedics. 1991;  14 263-270
    PubMedGoogle Scholar
  • 20 Tscherne H, Lobenhoffer P. Tibial plateau fractures. Management and expected results.  Clin Orthop Relat Res. 1993;  292 87-100
    PubMedGoogle Scholar
  • 21 Barrow B A, Fajman W A, Parker L M, Albert M J, Drvaric D M, Hudson T M. Tibial plateau fractures: evaluation with MR imaging.  Radiographics. 1994;  14 553-559
    PubMedGoogle Scholar
  • 22 Brophy D P, O'Malley M, Lui D, Denison B, Eustace S. MR imaging of tibial plateau fractures.  Clin Radiol. 1996;  51 873-878
    CrossrefPubMedGoogle Scholar
  • 23 Holt M D, Williams L A, Dent C M. MRI in the management of tibial plateau fractures.  Injury. 1995;  26 595-599
    CrossrefPubMedGoogle Scholar
  • 24 Kode L, Lieberman J M, Motta A O, Wilber J H, Vasen A, Yagan R. Evaluation of tibial plateau fractures: efficacy of MR imaging compared with CT.  AJR Am J Roentgenol. 1994;  163 141-147
    PubMedGoogle Scholar
  • 25 Shepherd L, Abdollahi K, Lee J, Vangsness Jr C T. The prevalence of soft tissue injuries in nonoperative tibial plateau fractures as determined by magnetic resonance imaging.  J Orthop Trauma. 2002;  16 628-631
    CrossrefPubMedGoogle Scholar
  • 26 Yacoubian S V, Nevins R T, Sallis J G, Potter H G, Lorich D G. Impact of MRI on treatment plan and fracture classification of tibial plateau fractures.  J Orthop Trauma. 2002;  16 632-637
    CrossrefPubMedGoogle Scholar
  • 27 Rüedi T P, Murphy W M, eds. AO Principles of Fracture Management. New York, Stuttgart: Thieme; 2000: 45-58
    Google Scholar
  • 28 Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968–1975.  Clin Orthop Relat Res. 1979;  138 94-104
    PubMedGoogle Scholar
  • 29 Mallik A R, Covall D J, Whitelaw G P. Internal versus external fixation of bicondylar tibial plateau fractures.  Orthop Rev. 1992;  21 1433-1436
    PubMedGoogle Scholar
  • 30 Shybut G T, Spiegel P G. Symposium. Rigid internal fixation of fractures. Tibial plateau fractures.  Clin Orthop Relat Res. 1979;  138 12-17
    PubMedGoogle Scholar
  • 31 Waddell J P, Johnston D W, Neidre A. Fractures of the tibial plateau: a review of ninety-five patients and comparison of treatment methods.  J Trauma. 1981;  21 376-381
    CrossrefPubMedGoogle Scholar
  • 32 Watson J T. High-energy fractures of the tibial plateau.  Orthop Clin North Am. 1994;  25 723-752
    PubMedGoogle Scholar
  • 33 Koval K J, Helfet D L. Tibial plateau fractures: evaluation and treatment.  J Am Acad Orthop Surg. 1995;  3 86-94
    CrossrefPubMedGoogle Scholar
  • 34 Kumar A, Whittle A P. Treatment of complex (Schatzker type VI) fractures of the tibial plateau with circular wire external fixation: retrospective case review.  J Orthop Trauma. 2000;  14 339-344
    CrossrefPubMedGoogle Scholar
  • 35 Mikulak S A, Gold S M, Zinar D M. Small wire external fixation of high energy tibial plateau fractures.  Clin Orthop Relat Res. 1998;  354 230-238
    PubMedGoogle Scholar
  • 36 Stamer D T, Schenk R, Staggers B, Aurori K, Aurori B, Behrens F F. Bicondylar tibial plateau fractures treated with a hybrid ring external fixator: a preliminary study.  J Orthop Trauma. 1994;  8 455-461
    PubMedGoogle Scholar
  • 37 Weigel D P, Marsh J L. High-energy fractures of the tibial plateau. Knee function after longer follow-up.  J Bone Joint Surg Am. 2002;  84 1541-1551
    CrossrefPubMedGoogle Scholar
  • 38 Stannard J P, Sheils T M, McGwin G, Volgas D A, Alonso J E. Use of a hinged external knee fixator after surgery for knee dislocation.  Arthroscopy. 2003;  19 626-631
    CrossrefPubMedGoogle Scholar
  • 39 Lansinger O, Bergman B, Körner L, Andersson GBJ. Tibial condylar fractures. A twenty-year follow-up.  J Bone Joint Surg Am. 1986;  68 13-19
    Google Scholar
  • 40 Mills W J, Nork S E. Open reduction and internal fixation of high-energy tibial plateau fractures.  Orthop Clin North Am. 2002;  33 177-198, ix
    CrossrefPubMedGoogle Scholar
  • 41 Gardner M J, Yacoubian S, Geller D et al.. The incidence of soft tissue injury in operative tibial plateau fractures: a magnetic resonance imaging analysis of 103 patients.  J Orthop Trauma. 2005;  19 79-84
    CrossrefPubMedGoogle Scholar
  • 42 Gardner M J, Yacoubian S, Geller D et al.. Prediction of soft-tissue injuries in Schatzker II tibial plateau fractures based on measurements of plain radiographs.  J Trauma. 2006;  60 319-323 discussion 324
    Google Scholar
  • 43 Stannard JP, Bankston L, Cobb J et al.. Fracture dislocation of the knee: clinical outcomes with a treatment protocol using a hinged external fixator. Presented at: American Orthopaedic Society for Sports Medicine 31st Annual Meeting; July 2005; Keystone, CO
    Google Scholar

James P StannardM.D. 

Department of Orthopaedic Surgery, University of Missouri Hospital

MC213 McHaney Hall, One Hospital Drive, Columbia, MO 65201

Email: stannardj@health.missouri.edu