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Posterior tibial slope angle is associated with flexion-type Salter–Harris II and Watson–Jones type IV fractures of the proximal tibia

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Flexion-type Salter–Harris (SH) II fractures of the proximal tibia, also described as Watson–Jones (WJ) IV fractures, are rare injuries reported among adolescent athletes who are close to skeletal maturity and remain elusive. Due to this classification disagreement, the various treatments range from nonoperative to operative types, and no previous studies have explained the mechanisms of injury or the source of the fracture forces. This retrospective matched case–control study aimed to identify radiological factors that are associated with the fracture forces and to elucidate the mechanisms of these injuries.

Methods

Sixteen flexion-type SH II/WJ IV fractures of the proximal tibia in 12 adolescents (12 males, mean age of 14.6 years) were retrospectively reviewed, and knee alignment on plain radiographs was assessed to compare the radiological outcomes of the operated knees (n = 7), nonoperated knees (n = 9), and uninjured contralateral knees (n = 8). The results were compared to healthy age- and sex-matched control subjects (n = 24 knees).

Results

With regard to the radiological outcomes, the posterior tibial slope angle (PTSA) was significantly greater in the nonoperated knees (19.0° ± 1.6°), operated knees (16.8° ± 1.3°), and uninjured knees (13.6° ± 1.3°) than in the healthy knees of the matched control subjects (9.6° ± 0.4°). The anatomical tibiofemoral angle was significantly less in the nonoperated knees (0.7° ± 0.6°) than in the healthy knees of the matched control subjects (3.7° ± 0.4°).

Conclusions

These findings suggest a relationship between an increased PTSA and flexion-type SH II/WJ IV fractures of the proximal tibia, considering the deteriorating effects of an increased PTSA on knee kinematics. Adolescent active athletes with an increased PTSA and partially closed epiphysis of the proximal tibia are at risk for suffering from flexion-type SH II/WJ IV fractures of the proximal tibia until the closure of the proximal tibial epiphysis.

Level of evidence

Case–control study, Level III.

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Acknowledgements

We would like to thank Hiroshi Hashiguchi for his valuable comments and great contributions to this study.

Funding

This research did not receive any specific grant from funding agencies.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamagari, Inzai, Chiba, 270-1694, Japan

    Hiroshi Watanabe

  2. Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan

    Hiroshi Watanabe, Tokifumi Majima, Kenji Takahashi, Norishige Iizawa, Yasushi Oshima & Shinro Takai

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  1. Hiroshi Watanabe
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  2. Tokifumi Majima
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  3. Kenji Takahashi
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  6. Shinro Takai
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Contributions

HW: study design, data analysis and interpretation, manuscript draft, revision, and approval. TM: study design, data interpretation, manuscript revision, and approval. KT: study design, data interpretation, manuscript revision, and approval. NI: literature review, manuscript revision, and approval. YO: study design, manuscript revision, and approval. ST: study design, manuscript revision, and approval.

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Correspondence to Hiroshi Watanabe.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The local medical ethics committee reviewed and approved the study (approval number 695). The rights of subjects were protected under the Declaration of Helsinki.

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Watanabe, H., Majima, T., Takahashi, K. et al. Posterior tibial slope angle is associated with flexion-type Salter–Harris II and Watson–Jones type IV fractures of the proximal tibia. Knee Surg Sports Traumatol Arthrosc 27, 2994–3000 (2019). https://doi.org/10.1007/s00167-018-5319-2

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  • DOI: https://doi.org/10.1007/s00167-018-5319-2

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