title: Sagittal plane deformity in bicondylar tibial plateau fractures.
abstract: OBJECTIVE
  To evaluate the prevalence and magnitude of sagittal plane deformity in bicondylar tibial plateau fractures.
  
  
  METHODS
  Retrospective radiographic review.
  
  
  METHODS
  Two Level I trauma centers.
  
  
  METHODS
  Sagittal inclination of the medial and lateral plateau measured in relation to the longitudinal axis of the tibia using computed tomographic reconstruction images.
  
  
  METHODS
  Seventy-four patients (mean age, 49 years; range, 16-82 years; 64% male) with acute bicondylar tibial plateau fractures (Orthopaedic Trauma Association 41C, Schatzker VI) treated from October 2006 to July 2009.
  
  
  RESULTS
  The average sagittal plane angulation of the lateral plateau was 9.8° posteriorly (range, 17° anteriorly to 37° posteriorly). The medial plateau was angulated 4.1° posteriorly on average (range, 16° anteriorly to 31° posteriorly). Forty-two lateral plateaus were angulated more than 5° from the "normal" anatomic slope (defined as 5° of posterior tibial slope). Of these, 76% were angulated posteriorly. Forty-three (58%) of the medial plateaus were angulated greater than 5° from normal, of which only 47% were inclined posteriorly (P = 0.019 compared with lateral plateaus). In 68% of patients, the difference between medial and lateral plateaus was greater than 5°; the average intercondylar slope difference was 9° (range, 0°-31°; P < 0.001). Spanning external fixation did not affect the slope of either the medial or lateral tibial plateau. Intraobserver and interobserver correlations were high for both the medial and lateral plateaus (r > 0.81, P < 0.01).
  
  
  CONCLUSIONS
  Considerable sagittal plane deformity exists in the majority of bicondylar tibial plateau fractures. The lateral plateau has a higher propensity for sagittal angulation and tends to have increased posterior slope. Most patients have a substantial difference between the lateral and medial plateau slopes. The identification of this deformity allows for accurate preoperative planning and specific reduction maneuvers to restore anatomic alignment.
authors.affiliation: Orthopaedic Trauma Service, Washington University School of Medicine/Barnes-Jewish Hospital, St Louis, MO 63110, USA. streubelp@wudosis.wustl.edu
authors.forename: Philipp N
authors.initials: PN
authors.lastname: Streubel
authors.forename: Donald
authors.initials: D
authors.lastname: Glasgow
authors.forename: Ambrose
authors.initials: A
authors.lastname: Wong
authors.forename: David P
authors.initials: DP
authors.lastname: Barei
authors.forename: William M
authors.initials: WM
authors.lastname: Ricci
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Gardner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017760:Bone Malalignment / Q000517:prevention & control; D005260:Female; D005592:Fracture Fixation / Q000379:methods*; D006801:Humans; D007718:Knee Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D013131:Spine / Q000002:abnormalities*; D013165:Splints; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult