title: Fractures of the tibial plateau involve similar energies as the tibial pilon but greater articular surface involvement.
abstract: Patients with tibial pilon fractures have a higher incidence of post-traumatic osteoarthritis than those with fractures of the tibial plateau. This may indicate that pilon fractures present a greater mechanical insult to the joint than do plateau fractures. We tested the hypothesis that fracture energy and articular fracture edge length, two independent indicators of severity, are higher in pilon than plateau fractures. We also evaluated whether clinical fracture classification systems accurately reflect severity. Seventy-five tibial plateau fractures and 52 tibial pilon fractures from a multi-institutional study were selected to span the spectrum of severity. Fracture severity measures were calculated using objective CT-based image analysis methods. The ranges of fracture energies measured for tibial plateau and pilon fractures were 3.2-33.2 Joules (J) and 3.6-32.2 J, respectively, and articular fracture edge lengths were 68.0-493.0 mm and 56.1-288.6 mm, respectively. There were no differences in the fracture energies between the two fracture types, but plateau fractures had greater articular fracture edge lengths (p < 0.001). The clinical fracture classifications generally reflected severity, but there was substantial overlap of fracture severity measures between different classes. Similar fracture energies with different degrees of articular surface involvement suggest a possible explanation for dissimilar rates of post-traumatic osteoarthritis for fractures of the tibial plateau compared to the tibial pilon. The substantial overlap of severity measures between different fracture classes may well have confounded prior clinical studies relying on fracture classification as a surrogate for severity. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:618-624, 2017.
authors.affiliation: Department of Orthopaedics and Rehabilitation, the University of Iowa, Iowa City, Iowa.
authors.forename: Kevin
authors.initials: K
authors.lastname: Dibbern
authors.affiliation: Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Laurence B
authors.initials: LB
authors.lastname: Kempton
authors.affiliation: Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Higgins
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California.
authors.forename: Saam
authors.initials: S
authors.lastname: Morshed
authors.affiliation: Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Todd O
authors.initials: TO
authors.lastname: McKinley
authors.affiliation: Department of Orthopaedics and Rehabilitation, the University of Iowa, Iowa City, Iowa.
authors.forename: J Lawrence
authors.initials: JL
authors.lastname: Marsh
authors.affiliation: Department of Orthopaedics and Rehabilitation, the University of Iowa, Iowa City, Iowa.
authors.forename: Donald D
authors.initials: DD
authors.lastname: Anderson
mesh_terms: D004735:Energy Transfer; D006801:Humans; D012720:Severity of Illness Index; D012984:Software; D013978:Tibial Fractures / Q000145:classification* / Q000000981:diagnostic imaging / Q000209:etiology
keywords: fracture severity; post-traumatic OA; tibial pilon; tibial plateau