J Korean Fract Soc.  2018 Oct;31(4):132-138. 10.12671/jkfs.2018.31.4.132.

Prediction of Concomitant Lateral Meniscus Injury with a Tibia Plateau Fracture Based on Computed Tomography Assessment

Affiliations
  • 1Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea. wcosdoc@gmail.com

Abstract

PURPOSE
This study examined whether any fracture pattern shown in computed tomography (CT) scan is associated with the presence of lateral meniscus (LM) injury in a tibia plateau fracture.
MATERIALS AND METHODS
Fifty-three tibia plateau fractures with both preoperative CT and magnetic resonance imagings (MRI) available were reviewed. The patient demographics, including age, sex, body mass index, and energy level of injury were recorded. The fracture type according to the Schatzker classification, patterns including the lateral plateau depression (LPD), lateral plateau widening (LPW), fracture fragment location, and the number of columns involved were assessed from the CT scans. The presence of a LM injury was determined from the MRI. The differences in the factors between the patients with (Group 1) and without (Group 2) LM injuries were compared and the correlation between the factors and the presence of LM injury was analyzed.
RESULTS
The LM was injured in 23 cases (Group 1, 43.4%) and intact in 30 cases (Group 2, 56.6%). The LPD in Group 1 (average, 8.2 mm; range, 3.0-20.0 mm) and Group 2 (average, 3.8 mm; range, 1.4-12.1 mm) was significantly different (p < 0.001). The difference in LPW of Group 1 (average, 6.9 mm; range, 1.2-15.3 mm) and Group 2 (average, 4.8 mm; range, 1.4-9.4 mm) was not significant (p=0.097). The other fracture patterns or demographics were similar between in the two groups. Regression analysis revealed that an increased LPD (p=0.003, odds ratio [OR]=2.12) and LPW (p=0.048, OR=1.23) were significantly related to the presence of a LM tear.
CONCLUSION
LPD and LPW measured from the CT scans were associated with an increased risk of concomitant LM injury in tibia plateau fractures. If such fracture patterns exist, concomitant LM injury should be considered and an MRI may be beneficial for an accurate diagnosis and effective treatment.

Keyword

Tibia; Lateral meniscus; Tibia plateau fracture; Computed tomography; Magnetic resonance image; Schatzker classification

MeSH Terms

Body Mass Index
Classification
Demography
Depression
Diagnosis
Humans
Magnetic Resonance Imaging
Menisci, Tibial*
Odds Ratio
Tears
Tibia*
Tomography, X-Ray Computed

Figure

  • Fig. 1. Lateral plateau depression (LPD) and lateral plateau widening (LPW) measurements from a coronal reformatted computed tomography imaging. LPD was defined as the perpendicular distance ‘A’ between a tangential line to the neutral plane of the articular surface and a tangential line to the lowest point of depression. LPW was defined as the perpendicular distance ‘B’ between a tangential line to the lateral femoral epicondyle and a parallel line drawn from the most lateral part of the lateral tibial plateau.

  • Fig. 2. A 52-year-old man presented with a Schatzker type II tibia plateau fracture of the left knee. (A) Computed tomography coronal reformatted imaging demonstrated 7.52 mm of lateral plateau depression and 4.44 mm of lateral plateau widening. (B) Meniscocapsular separation and central migration of lateral meniscus (white arrow) was shown in the coronal magnetic resonance imaging. (C) Lateral meniscus injury was confirmed during arthroscopy. (D) The lateral meniscus was repaired to the capsule using the inside-out repair technique.


Reference

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