Skip to main content

The prevalence of soft tissue injuries in operative Schatzker type IV tibial plateau fractures

Archives of Orthopaedic and Trauma Surgery volume 141, pages 1269–1275 (2021)Cite this article

Abstract

Background

To describe the incidence of soft-tissue injuries in patients with surgically treated Schatzker type IV tibial plateau fractures.

Methods

All tibial plateau fractures in skeletally mature patients treated operatively between January 2013 and August 2018 were retrospectively reviewed using a clinical medical record system. All fractures were categorized according to the AO/OTA classifications. Twenty-seven patients with Schatzker type IV tibial plateau fractures were further classified based on the Wahlquist classification. Associated soft-tissue injuries, which consisted of cruciate ligament injuries, and meniscal and collateral ligament injuries, were diagnosed through operation notes and magnetic resonance imaging (MRI) data. The categorical variables were tested by the chi-square test or Fisher’s exact test.

Results

The incidence of lateral meniscus tears and medial meniscus tears was 63% and 44.4% in Schatzker type IV tibial plateau fractures, respectively. Twenty-five (92.6%) patients had sustained anterior cruciate ligament (ACL) injuries, and 19 (70.4%) patients had an incomplete injury of the posterior cruciate ligament (PCL). There were 17 (63%) lateral collateral ligament (LCL) injuries, and 8 (29.6%) medial collateral ligament (MCL) injuries. Using the Wahlquist classification, these fractures were categorized as follows: type A, one patient; type B, six patients; type C, twenty patients. There was no significant difference between the type of fracture and the location of soft tissue injuries.

Conclusions

This study found that operative Schatzker type IV tibial plateau fractures represented a high incidence of soft-tissue injuries, especially LCL injuries, ACL injuries, and meniscus tears. Based on our data, we believe that soft-tissue injuries in operative Schatzker type IV tibial plateau fractures deserve more attention.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  1. Bennett WF, Browner B (1994) Tibial plateau fractures: a study of associated soft tissue injuries. J Orthop Trauma 8(3):183–188

    CAS  Article  Google Scholar 

  2. Berkson EM, Virkus WW (2006) High-energy tibial plateau fractures. J Am Acad Orthop Surg 14(1):20–31

    Article  Google Scholar 

  3. Chang SM, Zhang YQ, Yao MW, Du SC, Li Q, Guo Z (2014) Schatzker type IV medial tibial plateau fractures: a computed tomography-based morphological subclassification. Orthopedics 37(8):e699–706

    Article  Google Scholar 

  4. Colletti P, Greenberg H, Terk MR (1996) MR findings in patients with acute tibial plateau fractures. Comput Med Imaging Graph 20(5):389–394

    CAS  Article  Google Scholar 

  5. Fischer SP, Fox JM, Del Pizzo W, Friedman MJ, Snyder SJ, Ferkel RD (1991) Accuracy of diagnoses from magnetic resonance imaging of the knee. A multi-center analysis of one thousand and fourteen patients. J Bone Joint Surg Am 73(1):2–10

    CAS  Article  Google Scholar 

  6. Gardner MJ, Yacoubian S, Geller D et al (2005) The incidence of soft tissue injury in operative tibial plateau fractures: a magnetic resonance imaging analysis of 103 patients. J Orthop Trauma 19(2):79–84

    Article  Google Scholar 

  7. Gardner MJ, Yacoubian S, Geller D et al (2006) Prediction of soft-tissue injuries in Schatzker II tibial plateau fractures based on measurements of plain radiographs. J Trauma 60(2):319–323 (discussion 324)

    Article  Google Scholar 

  8. Higgins TF, Kemper D, Klatt J (2009) Incidence and morphology of the posteromedial fragment in bicondylar tibial plateau fractures. J Orthop Trauma 23(1):45–51

    Article  Google Scholar 

  9. Kfuri M, Schatzker J (2018) Revisiting the Schatzker classification of tibial plateau fractures. Injury 49(12):2252–2263

    Article  Google Scholar 

  10. Luo CF, Sun H, Zhang B, Zeng B-F (2010) Three-column fixation for complex tibial plateau fractures. J Orthop Trauma 24(11):683

    Article  Google Scholar 

  11. Markhardt BK, Gross JM, Monu JU (2009) Schatzker classification of tibial plateau fractures: use of CT and MR imaging improves assessment. Radiographics 29(2):585–597

    Article  Google Scholar 

  12. Marsh JL, Smith ST, Do TT (1995) External fixation and limited internal fixation for complex fractures of the tibial plateau. J Bone Joint Surg Am 77(75):661–673

    CAS  Article  Google Scholar 

  13. Moore TM (1981) Fracture—dislocation of the knee. Clin Orthop Relat Res 156:128–140

    Google Scholar 

  14. Moore TM, Meyers MH, Harvey JP Jr (1976) Collateral ligament laxity of the knee. Long-term comparison between plateau fractures and normal. J Bone Joint Surg Am 58(5):594–598

    CAS  Article  Google Scholar 

  15. Park HJ, Lee HD, Cho JH (2017) The efficacy of meniscal treatment associated with lateral tibial plateau fractures. Knee Surg Relat Res 29(2):137–143

    Article  Google Scholar 

  16. Purnell ML, Larson AI, Schnetzler KA, Harris NL, Pevny T (2007) Diagnosis and surgical treatment of Schatzker type IV variant biplanar medial tibial plateau fractures in alpine skiers. Tech Knee Surg 6(1):17–28

    Article  Google Scholar 

  17. Schatzker JMR, Bruce D (1979) The tibial plateau fracture. The Toronto experience 1968–1975. Clin Orthop Relat Res 138:94–104

    Google Scholar 

  18. Shepherd L, Abdollahi K, LeeVangsness JCT Jr (2002) The prevalence of soft tissue injuries in nonoperative tibial plateau fractures as determined by magnetic resonance imaging. J Orthop Trauma 16(9):628–631

    Article  Google Scholar 

  19. Stahl D, Serrano-Riera R, Collin K, Griffing R, Defenbaugh B, Sagi HC (2015) Operatively treated meniscal tears associated with tibial plateau fractures: a report on 661 patients. J Orthop Trauma 29(7):322–324

    Article  Google Scholar 

  20. Stannard J, Lopez R, Volgas D (2010) Soft tissue injury of the knee after tibial plateau fractures. J Knee Surg 23(4):187–192

    Article  Google Scholar 

  21. Twaddle BC, Bidwell TA, Chapman JR (2003) Knee dislocations: where are the lesions? A prospective evaluation of surgical findings in 63 cases. J Orthop Trauma 17(13):198–202

    Article  Google Scholar 

  22. Wahlquist M, Iaguilli N, Ebraheim N, Levine J (2007) Medial tibial plateau fractures: a new classification system. J Trauma 63(6):1418–1421

    PubMed  Google Scholar 

  23. Wang Y, Cao F, Liu M, Wang J, Jia S (2016) Incidence of soft-tissue injuries in patients with posterolateral tibial plateau fractures: a retrospective review from 2009 to 2014. J Knee Surg 29(6):451–457

    Article  Google Scholar 

  24. Zhai Q, Hu C, Xu Y, Wang D, Luo C (2015) Morphologic study of posterior articular depression in Schatzker IV fractures. Orthopedics 38(2):e124–128

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Xulan Wang for her help with the processing of the data.Yan loves Xulan a thousand times.

Funding

There is no funding source.

Author information

Affiliations

  1. Department of Orthopedic Surgery, Jinshan Hospital, Fudan University, Shanghai, 201508, People’s Republic of China

    Bingshan Yan, Jianwei Sun & Wangping Yin

Authors
  1. Bingshan Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jianwei Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wangping Yin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wangping Yin.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Yan, B., Sun, J. & Yin, W. The prevalence of soft tissue injuries in operative Schatzker type IV tibial plateau fractures. Arch Orthop Trauma Surg 141, 1269–1275 (2021). https://doi.org/10.1007/s00402-020-03533-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-020-03533-0

Keywords

  • Tibial plateau fractures
  • Schatzker type IV
  • Magnetic resonance imaging
  • Soft-tissue injury