How important are posterior tibial plateau fractures?  A review of the incidence, fragment characteristics, and mechanisms of injury

wich orapiriyakul; Theerachai Apivatthakakul; Chanakarn Phornphutkul

Authors

wich orapiriyakul Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Thailand
Theerachai Apivatthakakul Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Thailand
Chanakarn Phornphutkul Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Thailand

Keywords:

posterior tibial, plateau fracture, posterolateral tibial plateau fracture, tibial plateau fracture

Abstract

Posterior tibial plateau fracture is a common feature found in complex tibial plateau fractures. However, the fracture characteristics of posteromedial and posterolateral fragments are different. Various mechanisms of tibial plateau injuries result in diverse fracture types which require appropriate treatment strategies. To emphasize the importance and diversity of posterior tibial plateau fractures, the incidence and characteristics of those fractures is reviewed. In addition, integration of knowledge of mechanisms of injury and fracture characteristics with the selection of surgical procedures is discussed.

References

Luo CF, Sun H, Zhang B, Zeng BF. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma. 2010;24:683-92.

Chang SM, Hu SJ, Zhang YQ, Yao MW, Ma Z, Wang X, et al. A surgical protocol for bicondylar four-quadrant tibial plateau fractures. Int Orthop. 2014;38:2559-64.

Chen HW, Chen CQ, Yi XH. Posterior tibial plateau fracture: a new treatment-oriented classification and surgical management. Int J Clin Exp Med. 2015;8:472-9.

Krause M, Preiss A, Müller G, Madert J, Fehske K, Neumann MV, et al. Intra-articular tibial plateau fracture characteristics according to the “Ten segment classification”. Injury. 2016;47:2551-7.

Kim CW, Lee CR, An KC, Gwak HC, Kim JH, Wang L, et al. Predictors of reduction loss in tibial plateau fracture surgery: Focusing on posterior coronal fractures. Injury. 2016;47:1483-7.

Weaver MJ, Harris MB, Strom AC, Smith RM, Lhowe D, Zurakowski D, et al. Fracture pattern and fixation type related to loss of reduction in bicondylar tibial plateau fractures. Injury. 2012;43:864-9.

Waldrop JI, Macey TI, Trettin JC, Bourgeois WR, Hughston JC. Fractures of the posterolateral tibial plateau. Am J Sports Med. 1988;16:492-8.

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;133:929-34.

Zhai Q, Hu C, Xu Y, Wang D, Luo C. Morphologic study of posterior articular depression in Schatzker IV fractures. Orthopedics. 2015;38:e124-8.

Sohn HS, Yoon YC, Cho JW, Cho WT, Oh CW, Oh JK. Incidence and fracture morphology of posterolateral fragments in lateral and bicondylar tibial plateau fractures. J Orthop Trauma.2015; 29:91-7.

Zhu Y, Meili S, Dong MJ, Zhai QL, Yao L, Wang JC, et al. Pathoanatomy and incidence of the posterolateral fractures in bicondylar tibial plateau fractures: a clinical computed tomography-based measurement and the associated biomechanical model simulation. Arch Orthop Trauma Surg. 2014;134:1369-80.

Zhu Y, Yang G, Luo CF, Smith WR, Hu CF, Gao H, et al. Computed tomography-based Three-Column Classification in tibial plateau fractures: introduction of its utility and assessment of its reproducibility. J Trauma Acute Care Surg. 2012;73:731-7.

Chen P, Shen H, Wang W, Ni B, Fan Z, Lu H. The morphological features of different Schatzker types of tibial plateau fractures: a three-dimensional computed tomography study. J Orthop Surg Res. 2016;11:94.

Chang SM, Zheng HP, Li HF, Jia YW, Huang YG, Wang X, 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;129:955-62.

Chen HW, Liu GD, Ou S, Zhao GS, Pan J, Wu LJ. Open reduction and internal fixation of posterolateral tibial plateau fractures through fibula osteotomy-free posterolateral approach. J Orthop Trauma. 2014;28:513-7.

Tao J, Hang DH, Wang QG, Gao W, Zhu LB, Wu XF, et al. The posterolateral shearing tibial plateau fracture: treatment and results via a modified posterolateral

approach. Knee. 2008;15:473-9.

Liu GY, Xiao BP, Luo CF, Zhuang YQ, Xu RM, Ma WH. Results of a modified posterolateral approach for the isolated posterolateral tibial plateau fracture. Indian J Orthop. 2016;50:117-22.

Barei DP, O’Mara TJ, Taitsman LA, Dunbar RP, Nork SE. Frequency and fracture morphology of the posteromedial fragment in bicondylar tibial plateau fracture patterns. J Orthop Trauma. 2008;22:176-82.

Higgins TF, Kemper D, Klatt J. Incidence and morphology of the posteromedial fragment in bicondylar tibial plateau fractures. J Orthop Trauma. 2009;23:45-51.

Molenaars RJ, Mellema JJ, Doornberg JN, Kloen P. Tibial Plateau Fracture Characteristics: Computed Tomography Mapping of Lateral, Medial, and Bicondylar Fractures. J Bone Joint Surg Am. 2015;97:1512-20.

Xiang G, Zhi-Jun P, Qiang Z, Hang L. Morphological characteristics of posterolateral articular fragments in tibial plateau fractures. Orthopedics. 2013;36:e1256-61.

Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968-1975. Clin Orthop Relat Res. 1979;(138):94-104.

Wang Y, Luo C, Zhu Y, Zhai Q, Zhan Y, Qiu W, et al. Updated Three-Column Concept in surgical treatment for tibial plateau fractures - A prospective cohort study of 287 patients. Injury. 2016;47:1488-96.

Yao X, Xu Y, Yuan J, Lv B, Fu X, Wang L, et al. Classification of tibia plateau fracture according to the “four-column and nine-segment”. Injury. 2018;49:2275-83.

Yao J, Lancianese SL, Hovinga KR, Lee J, Lerner AL. Magnetic resonance image analysis of meniscal translation and tibio-menisco-femoral contact in deep knee flexion. J Orthop Res. 2008;26:673-84.

Johal P, Williams A, Wragg P, Hunt D, Gedroyc W. Tibio-femoral movement in the living knee. A study of weight bearing and non-weight bearing knee kinematics using ‘interventional’ MRI. J Biomech. 2005;38:269-76.

Immerman I, Bechtel C, Yildirim G, Heller Y, Walker PS, Egol KA. Stability of the posteromedial fragment in a tibial plateau fracture. J Knee Surg. 2013;26:117-26.

Cuéllar VG, Martinez D, Immerman I, Oh C, Walker PS, Egol KA. A biomechanical study of posteromedial tibial plateau fracture stability: Do they all require fixation? J Orthop Trauma. 2015;29:325-30.

Kennedy JC, Bailey WH. Experimental tibial-plateau fractures. Studies of the mechanism and a classification. J Bone Joint Surg Am. 1968;50:1522-34.

Eggli S, Hartel MJ, Kohl S, Haupt U, Exadaktylos AK, Röder C. Unstable bicondylar tibial plateau fractures: a clinical investigation. J Orthop Trauma. 2008;22:673-9.

Barei DP, Nork SE, Mills WJ, Coles CP, Henley MB, Benirschke SK. Functional outcomes of severe bicondylar tibial plateau fractures treated with dual incisions and medial and lateral plates. J Bone Joint Surg Am. 2006;88:1713-21.

Kim Y, Yoon YC, Cho JW, Cho WT, Jeon NH, Oh CW, et al. Rim plate augmentation of the posterolateral bare area of the tibial plateau using a 3.5-mm precontoured locking compression plate: A cadaveric study. J Orthop Trauma. 2018;32:e157-e60.

Chen P, Lu H, Shen H, Wang W, Ni B, Chen J. Newly designed anterolateral and posterolateral locking anatomic plates for lateral tibial plateau fractures: a finite element study. J Orthop Surg Res. 2017;12:35.

Jian Z, Ao R, Zhou J, Jiang X, Zhang D, Yu B. A new ana-tomic locking plate for the treatment of posterolateral tibial plateau fractures. BMC Musculoskelet Disord.

;19:319.

Heidari N, Lidder S, Grechenig W, Tesch NP, Weinberg AM. The risk of injury to the anterior tibial artery in the posterolateral approach to the tibia plateau: a cadaver study. J Orthop Trauma. 2013;27:221-5.

Sun H, Luo CF, Yang G, Shi HP, Zeng BF. Anatomical evaluation of the modified posterolateral approach for posterolateral tibial plateau fracture. Eur J Orthop Surg Traumatol. 2013;23:809-18.

Orapiriyakul W, Apivatthakakul T, Phornphutkul C. Posterolateral tibial plateau fractures, how to buttress? Reversed L posteromedial or the posterolateral approach: a comparative cadaveric study. Arch Orthop Trauma Surg. 2018;138:505-13.