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Tibial plateau fracture: does fracture classification influence the choice of surgical approach? A retrospective multicenter analysis

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

The role of classification systems for the choice of surgical approach and the management of tibial plateau fractures remains unclear. The purpose of this study was to investigate the potential of classification systems to choose the appropriate operative approach. Current surgical management strategies were investigated in a large multicenter assessment.

Methods

In this study, we retrospectively analyzed all patients with tibial plateau fractures that have received surgical treatment in one of the five Level I trauma facilities between 2012 and 2015. Fractures were classified in each center by a senior orthopedic surgeon using the AO/OTA and the Luo classification. Demographics, trauma mechanism, as well as the surgical approach were recorded.

Results

538 patients (46.1% male, 53.9% female) were included. The anterolateral approach was used most frequently with 54.8% of all single approaches; 76.2% of all combined approaches used anterolateral as part of the approach. Combined approaches were used in 22.5% of the cases; a combination of the anterolateral and medial (10%), anterolateral, and posteromedial approach (5.8%) were used most frequently. The lowest number was found for the posterolateral (1.3%) and the combined approaches dorsal/anterolateral and medial/dorsal (1.7%, 1.1%). The AO/OTA classification showed a peak for 41.B2 (21.9%) and B3 (35.5%) fractures. Regarding the Luo classification, the dorsal column was involved in 45.7%. In contrast, only 14.7% of the surgical approaches used were able to address the dorsal tibial plateau potentially.

Conclusion

The use of dorsal approach seems to be of minor importance than expected in daily clinical practice in this multicenter study. It was not possible to specify whether the AO/OTA or the Luo classification can reliably predict the choice of surgical approach. The operative treatment strategy of tibial plateau fractures seems to rather rely on the surgeons' experience, education, and preferences.

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Author information

Author notes

  1. Markus Rossmann and Florian Fensky contributed equally and therefore shared the first authorship.

Authors and Affiliations

  1. Department of Orthopedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstraße 2, 22767, Hamburg, Germany

    Markus Rossmann

  2. Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Florian Fensky

  3. Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Ann-Kathrin Ozga

  4. Department of Trauma and Hand Surgery, Clinical Center Osnabrück, Am Finkenhügel 1-3, 49076, Osnabrück, Germany

    Johannes M. Rueger

  5. Center of Musculoskeletal Surgery, Charité-University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Sven Märdian & Gabriele Russow

  6. Clinic for Orthopedics and Trauma Surgery, Center for Orthopedics Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany

    Ulf Brunnemer & Gerhard Schmidmaier

  7. Department of Traumatology and Orthopedics 1, Westpfalz-Clinics Kaiserslautern, Hellmut-Hartert-Straße 1, 67655, Kaiserslautern, Germany

    Alexander Hofmann

  8. Department of Trauma, Hand and Reconstructive Surgery, Medical Center, University of Rostock, Schillingallee 35, 18057, Rostock, Germany

    Philipp Herlyn & Thomas Mittlmeier

  9. Department of Trauma and Orthopedic Surgery, Clinical Center Braunschweig, Holwedestraße 16, 38118, Brunswick, Germany

    Ahmed Amer & Thomas Gösling

  10. Department of Orthopedics, Trauma and Spine Surgery, Asklepios Hospital Hamburg Altona, Paul-Ehrlich-Straße 1, 22763, Hamburg, Germany

    Lars G. Grossterlinden

Authors
  1. Markus Rossmann
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  2. Florian Fensky
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  3. Ann-Kathrin Ozga
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  4. Johannes M. Rueger
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  5. Sven Märdian
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  6. Gabriele Russow
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  7. Ulf Brunnemer
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  8. Gerhard Schmidmaier
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  9. Alexander Hofmann
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  10. Philipp Herlyn
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  11. Thomas Mittlmeier
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  12. Ahmed Amer
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  13. Thomas Gösling
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  14. Lars G. Grossterlinden
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Corresponding author

Correspondence to Lars G. Grossterlinden.

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Conflict of interest

The authors declare that they have no conflict of interest concerning this article.

Ethical approval

The project was approved by the local ethics committee.

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Rossmann, M., Fensky, F., Ozga, AK. et al. Tibial plateau fracture: does fracture classification influence the choice of surgical approach? A retrospective multicenter analysis. Eur J Trauma Emerg Surg 48, 3635–3641 (2022). https://doi.org/10.1007/s00068-020-01388-z

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  • DOI: https://doi.org/10.1007/s00068-020-01388-z

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