Skip to main content

Advertisement

SpringerLink
Log in

Area of the plateau depression and higher age predict post-operative subsidence in split-depression lateral tibial fracture

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Introduction

The aim of this study was to determine factors that affect post-operative subsidence in split-depression lateral plateau tibial fracture (OTA/AO 41B3.1) which was treated with raft construct through a locking plate.

Patients and methods

The retrospective study evaluated all split-depression lateral plateau tibial fracture cases treated with raft construct through a locking plate between 01/2015 and 04/2020 with a minimum of 12-month follow-up. Data on the patients’ age, sex, time from injury to surgery, type of plate, and use of subchondral bone defect filler were retrieved from the hospital database. The measurements of total plateau area (TPA), depressed lateral plateau area (DPA), and maximal plateau depression (MPD) were performed on the patients’ pre-operative CT scans. The percentage of DPA to TPA (%DPA) was calculated. Post-operative radiographs were used for the evaluation of plateau subsidence. A subsidence greater than 2 mm was considered a failure.

Results

There were 41 consecutive cases of split-depression lateral plateau tibial fracture in the reviewed period. Five cases were excluded, three of them were lost to follow up, 1 patient had no pre-operative CT scan and 1 had a history of cancer. A failure was identified in 11 (31%) cases. Patients in the failure group were older (61.0 vs 50.7 years, p = 0.01), and had a higher incidence of fractures extending into intercondylar eminence (100% vs 56%, p = 0.02). Multiple logistic regression identified DPA (OR = 3.6; 95%CI 1.4–9.5, p < 0.01) and age (OR = 1.2; 95% CI 1.0–1.4, p = 0.02) as predictive factors for plateau subsidence.

DPA cut-off value for predicting subsidence greater than 2 mm was 5.8 cm2 [Area Under the ROC Curve 0.89 (95% CI 0.74–0.97), sensitivity 91%, specificity 80%, p < 0.01)].

Conclusion

Age and depressed lateral plateau area (DPA) in split-depression lateral plateau tibial fracture treated with raft construct through a locking plate are risk factors for post-operative subsidence greater than 2 mm.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Elsø R, Larsen P, Nielsen NPH, Swenne J, Rasmussen S, Østgaard SE. Population-based epidemiology of tibial plateau fractures. Orthopedics. 2015;38:e780–6.

    Google Scholar 

  2. Krause M, Preiss A, Müller G, Madert J, Fehske K, Neumann MV, et al. Intra-articular tibial plateau fracture characteristics according to the “Ten segment classification.” Injury. 2016;47:2551–7.

    Article  PubMed  Google Scholar 

  3. Meinberg E, Agel J, Roberts C, Karam M, Kellam J. Fracture and dislocation classification compendium—2018. J Orthop Trauma. 2018;32:S1-170.

    Article  PubMed  Google Scholar 

  4. Pean CA, Driesman A, Christiano A, Konda SR, Davidovitch R, Egol KA. Functional and clinical outcomes of nonsurgically managed tibial plateau fractures. J Am Acad Orthop Surg. 2017;25:375–80.

    Article  PubMed  Google Scholar 

  5. Karunakar MA, Egol KA, Peindl R, Harrow ME, Bosse MJ, Kellam JF. Split depression tibial plateau fractures: a biomechanical study. J Orthop Trauma. 2002;16:172–7.

    Article  PubMed  Google Scholar 

  6. Cross WW 3rd, Levy BA, Morgan JA, Armitage BM, Cole PA. Periarticular raft constructs and fracture stability in split-depression tibial plateau fractures. Injury. 2013;44:796–801.

    Article  PubMed  Google Scholar 

  7. Oh CW, Park KC, Jo YH. Evaluating augmentation with calcium phosphate cement (chronOS Inject) for bone defects after internal fixation of proximal tibial fractures: a prospective, multicenter, observational study. Orthop Traumatol Surg Res. 2017;103:105–9.

    Article  CAS  PubMed  Google Scholar 

  8. Ye X, Huang D, Perriman DM, Smith PN. Influence of screw to joint distance on articular subsidence in tibial-plateau fractures. ANZ J Surg. 2019;89:320–4.

    Article  PubMed  Google Scholar 

  9. Russell TA, Leighton RK. Comparison of autogenous bone graft and endothermic calcium phosphate cement for defect augmentation in tibial plateau fractures. A multicenter, prospective, randomized study. J Bone Jt Surg. 2008;90:2057–61.

    Article  Google Scholar 

  10. Kim C-W, Lee C-R, An K-C, Gwak H-C, Kim J-H, Wang L, et al. Predictors of reduction loss in tibial plateau fracture surgery: Focusing on posterior coronal fractures. Injury. 2016;47:1483–7.

    Article  PubMed  Google Scholar 

  11. Singleton N, Sahakian V, Muir D. Outcome after tibial plateau fracture: how important is restoration of articular congruity? J Orthop Trauma. 2017;31:158–63.

    Article  PubMed  Google Scholar 

  12. Parkkinen M, Madanat R, Mustonen A, Koskinen SK, Paavola M, Lindahl J. Factors predicting the development of early osteoarthritis following lateral tibial plateau fractures: mid-term clinical and radiographic outcomes of 73 operatively treated patients. Scand J Surg. 2014;103:256–62.

    Article  CAS  PubMed  Google Scholar 

  13. Rosteius T, Rausch V, Pätzholz S, Lotzien S, Königshausen M, Schildhauer TA, et al. Factors influencing the outcome after surgical reconstruction of OTA type B and C tibial plateau fractures: how crucial is the restoration of articular congruity? Arch Orthop Trauma Surg. 2022. https://doi.org/10.1007/s00402-022-04405-5.

    Article  PubMed  Google Scholar 

  14. Kulkarni SG, Tangirala R, Malve SP, Kulkarni MG, Kulkarni VS, Kulkarni RM, et al. Use of a raft construct through a locking plate without bone grafting for split-depression tibial plateau fractures. J Orthop Surg. 2015;23:331–5.

    Article  Google Scholar 

  15. Lobenhoffer P, Gerich T, Witte F, Tscherne H. Use of an injectable calcium phosphate bone cement in the treatment of tibial plateau fractures: a prospective study of twenty-six cases with twenty-month mean follow-up. J Orthop Trauma. 2002;16:143–9.

    Article  CAS  PubMed  Google Scholar 

  16. Parkkinen M, Lindahl J, Mäkinen TJ, Koskinen SK, Mustonen A, Madanat R. Predictors of osteoarthritis following operative treatment of medial tibial plateau fractures. Injury. 2018;49:370–5.

    Article  PubMed  Google Scholar 

  17. Pountos I, Giannoudis PV. Articular impaction injuries in the lower limb. EFORT Open Rev. 2017;2:250–60.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Keating JF, Hajducka CL, Harper J. Minimal internal fixation and calcium-phosphate cement in the treatment of fractures of the tibial plateau. A pilot study. J Bone Jt Surg. 2003;85:68–73.

    Article  CAS  Google Scholar 

  19. Ding M, Dalstra M, Danielsen CC, Kabel J, Hvid I, Linde F. Age variations in the properties of human tibial trabecular bone. J Bone Jt Surg. 1997;79:995–1002.

    Article  CAS  Google Scholar 

  20. Molenaars RJ, Mellema JJ, Doornberg JN, Kloen P. Tibial plateau fracture characteristics: computed tomography mapping of lateral, medial, and bicondylar fractures. J Bone Jt Surg. 2015;97:1512–20.

    Article  Google Scholar 

  21. Giordano V, Pires RE, Kojima KE, Fischer ST, Giannoudis PV. Subchondral rafting plate for the treatment of fragmented articular central depression tibial plateau fracture patterns: case series and technical illustration. Cureus. 2021;13:e12740. https://doi.org/10.7759/cureus.12740.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Univerzitna Nemocnica L Pasteura, Košice, Slovakia

    Radoslav Morochovič, Rastislav Burda, Martin Paulo, Peter Cibur & Ľuboš Tomčovčík

  2. P.J.Šafárik University, Faculty of Medicine, Košice, Slovakia

    Radoslav Morochovič, Rastislav Burda, Peter Cibur, Ľuboš Tomčovčík & Marian Sedlák

Authors
  1. Radoslav Morochovič
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rastislav Burda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martin Paulo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter Cibur
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ľuboš Tomčovčík
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marian Sedlák
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Radoslav Morochovič.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This research study was conducted retrospectively from data obtained for clinical purposes.

Informed consent

The local ethics committee reviewed and approved the study protocol 2021/EK/08050.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Morochovič, R., Burda, R., Paulo, M. et al. Area of the plateau depression and higher age predict post-operative subsidence in split-depression lateral tibial fracture. Eur J Trauma Emerg Surg 49, 393–399 (2023). https://doi.org/10.1007/s00068-022-02086-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-022-02086-8

Keywords

Search

Navigation