title: Predictors of reduction loss in tibial plateau fracture surgery: Focusing on posterior coronal fractures.
abstract: BACKGROUND
  Some studies have reported that fracture pattern was associated with reduction loss after surgery. The purpose of this study was to evaluate various factors that can influence reduction loss, including fracture patterns in unicondylar and bicondylar tibial plateau fractures.
  
  
  METHODS
  A total of 138 tibial plateau fractures that underwent open reduction and internal fixation using plates were retrospectively reviewed. The OTA/AO classification, fracture pattern, degree of comminution, and existence of reduction loss were evaluated based on simple radiographs and computed tomography. Patient information, including age, gender, and occupation, were acquired through chart reviews. The effect of each variable on reduction loss was evaluated through multiple logistic regression analysis.
  
  
  RESULTS
  Of 138 knees, reduction loss was observed in 40 knees (29.0%). Reduction loss was found in 11 (20.4%) of the type B knees (54 knees) and 29 (34.5%) of the type C knees (84 knees), according to the OTA/AO classification. The multiple logistic regression analysis for all cases revealed that the existence of comminution and coronal fracture influenced the occurrence of reduction loss, with odds ratios of 9.148 and 4.823, respectively (P<0.001 and P=0.001, respectively). In type B and type C, according to the OTA/AO classification, the existence of comminution and coronal fracture had causal relationships with the occurrence of reduction loss. The odds ratios of comminution and coronal fracture for reduction loss for type B were 9.114 and 9.117, respectively (P=0.019 and P=0.031, respectively), and the odds ratios for type C were 8.490 and 4.782, respectively (P=0.001 and 0.009, respectively).
  
  
  CONCLUSIONS
  When a tibial plateau fracture has a coronal fracture, if it is difficult to fix its fragments rigidly with medial or lateral plate fixation; therefore, buttress plating or direct fixation of fragments through the posteromedial, posterolateral, or posterior approach should be considered.
authors.affiliation: Department of Orthopedic Surgery, College of Medicine, Inje University, Busan Paik Hospital, 75, Bokji-ro, Busanjin-gu, Busan 47392, Republic of Korea.
authors.forename: Chang-Wan
authors.initials: CW
authors.lastname: Kim
authors.affiliation: Department of Orthopedic Surgery, College of Medicine, Inje University, Busan Paik Hospital, 75, Bokji-ro, Busanjin-gu, Busan 47392, Republic of Korea. Electronic address: leechangrack@gmail.com.
authors.forename: Chang-Rack
authors.initials: CR
authors.lastname: Lee
authors.affiliation: Department of Orthopedic Surgery, College of Medicine, Inje University, Busan Paik Hospital, 75, Bokji-ro, Busanjin-gu, Busan 47392, Republic of Korea.
authors.forename: Ki-Chan
authors.initials: KC
authors.lastname: An
authors.affiliation: Department of Orthopedic Surgery, College of Medicine, Inje University, Busan Paik Hospital, 75, Bokji-ro, Busanjin-gu, Busan 47392, Republic of Korea.
authors.forename: Heui-Chul
authors.initials: HC
authors.lastname: Gwak
authors.affiliation: Department of Orthopedic Surgery, College of Medicine, Inje University, Busan Paik Hospital, 75, Bokji-ro, Busanjin-gu, Busan 47392, Republic of Korea.
authors.forename: Jung-Han
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Orthopedic Surgery, College of Medicine, Dong-A University, 26, Daesingongwon-ro, Seo-gu, Busan 49201, Republic of Korea.
authors.forename: Lih
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Orthopedic Surgery, College of Medicine, Inje University, Busan Paik Hospital, 75, Bokji-ro, Busanjin-gu, Busan 47392, Republic of Korea.
authors.forename: Dong-Gil
authors.initials: DG
authors.lastname: Yoon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D001860:Bone Plates; D004867:Equipment Design; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D017102:Fracture Healing; D018460:Fractures, Comminuted / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: Comminution; Coronal fracture; Reduction loss; Tibial plateau fracture