Intra-articular tibial plateau fracture characteristics according to the "Ten segment classification".
BACKGROUND
Currently existing classifications of tibial plateau fractures do not help to guide surgical strategy. Recently, a segment-based mapping of the tibial plateau has been introduced in order to address fractures with a fracture-specific surgical approach. The goal of the present study was to analyze incidence and fracture specifics according to a new 10-segment classification of the tibial plateau.


METHODS
A total of 242 patients with 246 affected knees were included (124 females, 118 males, mean age 51.9±16.1years). Fractures were classified according to the OTA/AO classification. Fracture pattern was analyzed with respect to a 10-segment classification based on CT imaging of the proximal tibial plateau 3cm below the articular surface.


RESULTS
161 Patients suffered an OTA/AO type 41-B and 85 patients an OTA/AO type 41-C tibial plateau fracture. Females had an almost seven times higher risk to suffer a fracture due to low-energy trauma (OR 6.91, 95% CI (3.52, 13.54), p<0.001) than males. In 34% of the patients with affection of the medial tibial plateau, a fracture comminution, primarily due to low-energy trauma (p<0.001), was observed. In type B fractures, the postero-latero-lateral (65.2%), the antero-latero-lateral (64.6%) and the antero-latero-central (60.9%) segment were most frequently affected. Every second type C fracture showed an unique fracture line and zone of comminution. The tibial spine was typically involved (89.4%). A typical fracture pattern of high-energy trauma demonstrated a zone of comminution of the lateral plateau and a split fracture in the medial plateau. The most frequently affected segments were the postero-latero-central (85.9%), postero-central (84.7%), and antero-latero-central (78.8%) segment.


CONCLUSIONS
Posterior segments were the most frequently affected in OTA/AO type B and C fractures. Acknowledging the restricted visibility of posterior segments, whose reduction and fixation is crucial for long-term success, our findings implicate the use of posterior approaches more often in the treatment of tibial plateau fractures. Also, low-energy trauma was identified as an important cause for tibial plateau fractures.
Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Hamburg, Germany; "Fracture committee" of the German Knee Society, Germany.
Matthias
M
Krause
Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Hamburg, Germany; Department of Knee and Shoulder Surgery, Sports Traumatology, Asklepios Clinic St. Georg, Hamburg, Germany.
Achim
A
Preiss
Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Hamburg, Germany.
Gunnar
G
Müller
Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Hamburg, Germany.
Jürgen
J
Madert
Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Wuerzburg, Germany; "Fracture committee" of the German Knee Society, Germany.
Kai
K
Fehske
University Medical Center Freiburg, Department of Orthopaedics and Trauma Surgery, Freiburg i. Brsg., Germany; "Fracture committee" of the German Knee Society, Germany.
Mirjam V
MV
Neumann
Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Germany; "Fracture committee" of the German Knee Society, Germany.
Christoph
C
Domnick
Department of Trauma, Hand and Reconstructive Surgery, Westphalian Wilhelms University Muenster, Germany; "Fracture committee" of the German Knee Society, Germany.
Michael
M
Raschke
University Medical Center Freiburg, Department of Orthopaedics and Trauma Surgery, Freiburg i. Brsg., Germany; "Fracture committee" of the German Knee Society, Germany.
Norbert
N
Südkamp
Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Hamburg, Germany; Department of Knee and Shoulder Surgery, Sports Traumatology, Asklepios Clinic St. Georg, Hamburg, Germany; "Fracture committee" of the German Knee Society, Germany. Electronic address: khfrosch@me.com.
Karl-Heinz
KH
Frosch
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D018460:Fractures, Comminuted / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D021621:Imaging, Three-Dimensional; D015994:Incidence; D057072:Intra-Articular Fractures / Q000145:classification / Q000000981:diagnostic imaging* / Q000473:pathology; D007718:Knee Injuries / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000000981:diagnostic imaging* / Q000473:pathology; D014057:Tomography, X-Ray Computed; D055815:Young Adult
10-Segment classification; Epidemiology; Intraarticular tibial plateau fracture; Low-energy trauma