J Korean Fract Soc.  2013 Oct;26(4):241-247. 10.12671/jkfs.2013.26.4.241.

Analysis of Risk Factors for the Posterolateral Articular Depression and Status of Posterolateral Fragment in Lateral Condylar and Bicondylar Tibial Plateau Fractures with Joint Depression

• Choi JY
• Shin YW
• Lee BJ

• KMID: 2183823
• DOI: http://doi.org/10.12671/jkfs.2013.26.4.241

Abstract

PURPOSE
To evaluate risk factors of posterolateral articular depression and characteristics of the posterolateral fragment in lateral condylar and bicondylar tibial plateau fractures with joint depression.
MATERIALS AND METHODS
We reviewed 48 patients of Schatzker type II and type V (type II 34, type V 14) and evaluated risk factors of posterolateral articular depression according to the posterolateral fragment, fibular fracture, and Schatzker classification. We evaluated the position of articular depression and anterolateral fracture line of the posterolateral fragment and measured anterior to posterior lengths of the posterolateral fragment.
RESULTS
Posterolateral articular depression was found in 20 of 34 cases (59%) with coexisting posterolateral fragment and in 16 of 21 cases (76%) with coexisting fibular fracture. There was a significant difference in the occurrence of posterolateral articular depression with the existence of the posterolateral fragment and fibular fracture (p<0.001). Multivariate regression analysis revealed that fibular fracture increased the occurrence of posterolateral articular depression (odds ratio 24.5, 95% confidence interval 2.2-267.2). Fifty-seven percentage of the anterolateral fracture line of the posterolateral fragment existed posterior to the anterior margin of the fibular head.
CONCLUSION
This study showed that fibular fracture affects posterolateral articular depression in Schatzker type II and V tibial plateau fractures. Selecting a fixation device and performing fracture reduction requires a careful consideration since the anterolateral fracture line of the posterolateral fragment exists posterior to the anterior margin of the fibular head.

Keyword

Tibial plateau fracture; Fibular fracture; Posterolateral fragment; Schatzker classification

MeSH Terms

Head
Humans
Joints*
Risk Factors*

Figure

• 

  Fig. 1 Three demensional computed tomographys show the position of articular depression center in tibial plateau fractures. A line is the connecting line between the medial and lateral posterior cortex of the tibial plateau. B line is the parallel line to A line that crossing the anterior border of the lateral tibial condyle. C line is the bisecting line between lines A and B, which divide anterior and posterior depression. The position of joint depression is marked with an asterisk. (A) Anterior depression of tibial plateau fracture. (B) Posterior depression of tibial plateau fracture.

• 

  Fig. 2 Photograph shows the anterior-posterior length of the posterolateral fragment with three dimensional computed tomography. A: lateral collateral ligament, B: biceps femoris muscle, C: distance between the posterior margin of the posterior condyle and the anterior margin of the posterolateral fragment, D: distance between the anterior margin of the fibular head and the anterior margin of the posterolateral fragment.

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