Skip to main content

Radiographic detection of lateral plateau involvement in medial tibial plateau fractures (AO/OTA 41-B1.2, 1.3, 3.2 and 3.3)

Abstract

Purpose

To assess the accuracy of radiographs in detecting the lateral plateau involvement of medial tibial plateau fractures as well as describe the impact of CT on preoperative planning for this specific fracture morphology.

Methods

Radiograph and CT imaging of patients with a Schatzker type IV tibial plateau fractures (AO/OTA 41-B1.2, B1.3 h, B2.2. B3.2, and B3.3) between January 2013 and July 2017 were reviewed by three trauma fellowship-trained orthopedic surgeons to identify fractures of the medial condyle with an intact anterolateral articular surface.

Results

Lateral plateau involvement was identified in 16 (37%) radiographs and 26 (61%) CT images (p = 0.051). Radiographic detection of lateral plateau involvement demonstrated a sensitivity of 62% and specificity of 100%, and radiographs were able to predict the recommendation for surgical intervention for lateral plateau involvement with a positive predictive value (PPV) of 75% and a negative predictive value (NPV) of 60% compared to recommendations based on CT imaging. Radiographs predicted a need for a separate surgical approach with PPV of 63% and NPV of 70% when compared to recommendations based on CT images.

Conclusions

Radiographs are reliable in ruling in lateral plateau involvement of medial plateau fractures, but occult lateral articular extension may only be identified in CT imaging for some cases. Surgical planning may be impacted by CT imaging for this fracture morphology, but further study is warranted to evaluate the correlation between preoperative planning and clinical outcomes.

Level of Evidence

III.

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

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

References

  1. 1.

    Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37:691–697

    Article  Google Scholar 

  2. 2.

    Schatzker J, McBroom R, Bruce D (1979) The tibial plateau fracture. The Toronto experience 1968–1975. Clin Orthop Relat Res 139:94–104

    Google Scholar 

  3. 3.

    Chang S-M, Zhang Y-Q, Yao M-W et al (2014) Schatzker type IV medial tibial plateau fractures: a computed tomography-based morphological subclassification. Orthopedics 37:e699-706

    PubMed  Google Scholar 

  4. 4.

    Doornberg JN, Rademakers MV, van den Bekerom MP et al (2011) Two-dimensional and three-dimensional computed tomography for the classification and characterisation of tibial plateau fractures. Injury 42:1416–1425

    PubMed  Article  Google Scholar 

  5. 5.

    Molenaars RJ, Mellema JJ, Doornberg JN, Kloen P (2015) Tibial plateau fracture characteristics: computed tomography mapping of lateral, medial, and bicondylar fractures. J Bone Joint Surg Am 97:1512–1520

    PubMed  Article  Google Scholar 

  6. 6.

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

    PubMed  Google Scholar 

  7. 7.

    Yang G, Zhu Y, Luo C, Putnis S (2012) Morphological characteristics of Schatzker type IV tibial plateau fractures: a computer tomography based study. Int Orthop 36:2355–2360

    PubMed  PubMed Central  Article  Google Scholar 

  8. 8.

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

    Google Scholar 

  9. 9.

    Brunner A, Horisberger M, Ulmar B et al (2010) Classification systems for tibial plateau fractures; does computed tomography scanning improve their reliability? Injury 41:173–178

    PubMed  Article  Google Scholar 

  10. 10.

    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    CAS  Article  Google Scholar 

  11. 11.

    Millar SC, Arnold JB, Thewlis D et al (2018) A systematic literature review of tibial plateau fractures: What classifications are used and how reliable and useful are they? Injury 49:473–490

    PubMed  Article  Google Scholar 

  12. 12.

    Meinberg EG, Agel J, Roberts CS et al (2018) Fracture and dislocation classification compendium-2018. J Orthop Trauma 32(Suppl 1):S1–S170

    Article  Google Scholar 

  13. 13.

    Wang Y, Luo C, Zhu Y et al (2016) Updated three-column concept in surgical treatment for tibial plateau fractures—a prospective cohort study of 287 patients. Injury 47:1488–1496

    PubMed  Article  Google Scholar 

  14. 14.

    Luo C-F, Sun H, Zhang B, Zeng B-F (2010) Three-column fixation for complex tibial plateau fractures. J Orthop Trauma 24:683–692

    PubMed  PubMed Central  Article  Google Scholar 

  15. 15.

    Chen H-W, Liu G-D, Ou S et al (2014) Open reduction and internal fixation of posterolateral tibial plateau fractures through fibula osteotomy-free posterolateral approach. J Orthop Trauma 28:513–517

    PubMed  Article  Google Scholar 

  16. 16.

    Gebel PJ, Tryzna M, Beck T, Wilhelm B (2018) Tibial plateau fractures: Fracture patterns and computed tomography evaluation of tibial plateau fractures in winter sports. Orthop Rev 10:7517

    Article  Google Scholar 

  17. 17.

    Gicquel T, Najihi N, Vendeuvre T et al (2013) Tibial plateau fractures: reproducibility of three classifications (Schatzker, AO, Duparc) and a revised Duparc classification. Orthop Traumatol Surg Res 99:805–816

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  18. 18.

    Hoekstra H (2017) Are there four tibia plateau columns? Int Orthop 41:2631–2632

    PubMed  Article  PubMed Central  Google Scholar 

  19. 19.

    Hoekstra H, Kempenaers K, Nijs S (2017) A revised 3-column classification approach for the surgical planning of extended lateral tibial plateau fractures. Eur J Trauma Emerg Surg 43:637–643

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  20. 20.

    Krause M, Preiss A, Meenen NM et al (2016) “Fracturoscopy” is superior to fluoroscopy in the articular reconstruction of complex tibial plateau fractures-an arthroscopy assisted fracture reduction technique. J Orthop Trauma 30:437–444

    PubMed  Article  Google Scholar 

  21. 21.

    Krause M, Preiss A, Müller G et al (2016) Intra-articular tibial plateau fracture characteristics according to the “ten segment classification.” Injury 47:2551–2557

    PubMed  Article  Google Scholar 

  22. 22.

    Yao X, Xu Y, Yuan J et al (2018) Classification of tibia plateau fracture according to the “four-column and nine-segment.” Injury 49:2275–2283

    PubMed  Article  Google Scholar 

  23. 23.

    Chang S-M (2011) Selection of surgical approaches to the posterolateral tibial plateau fracture by its combination patterns. J Orthop Trauma 25(e32):e32–e33

    PubMed  Article  Google Scholar 

  24. 24.

    Chang S-M, Hu S-J, Du S-C et al (2018) Four-quadrant/column classification of tibial plateau fractures. Int Orthop 42:725–727

    PubMed  Article  Google Scholar 

  25. 25.

    Anwar A, Zhang Y, Zhao Z et al (2019) Two column classification of tibial plateau fractures; description, clinical application and reliability. Injury 50:1247–1255

    PubMed  Article  Google Scholar 

  26. 26.

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

    PubMed  Article  Google Scholar 

  27. 27.

    Barei DP, Nork SE, Mills WJ et al (2004) Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique. J Orthop Trauma 18:649–657

    Article  Google Scholar 

  28. 28.

    Lobenhoffer P, Gerich T, Bertram T et al (1997) Treatment of posterior tibial plateau fractures via posteromedial and posterolateral exposures. Unfallchirurg 100:957–967

    CAS  PubMed  Article  Google Scholar 

  29. 29.

    De Boeck H, Opdecam P (1995) Posteromedial tibial plateau fractures. Operative treatment by posterior approach. Clin Orthop Relat Res 320:125–128

    Google Scholar 

  30. 30.

    Chang S-M, Wang X, Zhou J-Q et al (2012) Posterior coronal plating of bicondylar tibial plateau fractures through posteromedial and anterolateral approaches in a healthy floating supine position. Orthopedics 35:583–588

    PubMed  Article  Google Scholar 

  31. 31.

    Chiu C-H, Cheng C-Y, Tsai M-C et al (2013) Arthroscopy-assisted reduction of posteromedial tibial plateau fractures with buttress plate and cannulated screw construct. Arthroscopy 29:1346–1354

    PubMed  Article  Google Scholar 

  32. 32.

    Espinoza-Ervin CZ, Starr AJ, Reinert CM et al (2009) Use of a midline anterior incision for isolated medial tibial plateau fractures. J Orthop Trauma 23:148–153

    PubMed  Article  Google Scholar 

  33. 33.

    Potocnik P, Acklin YP, Sommer C (2011) Operative strategy in postero-medial fracture-dislocation of the proximal tibia. Injury 42:1060–1065

    PubMed  Article  Google Scholar 

  34. 34.

    Sciadini MF, Sims SH (2013) Proximal tibial intra-articular osteotomy for treatment of complex Schatzker type IV tibial plateau fractures with lateral joint line impaction: description of surgical technique and report of nine cases. J Orthop Trauma 27:e18-23

    PubMed  Article  Google Scholar 

  35. 35.

    Solomon LB, Stevenson AW, Baird RPV, Pohl AP (2010) Posterolateral transfibular approach to tibial plateau fractures: technique, results, and rationale. J Orthop Trauma 24:505–514

    PubMed  Article  Google Scholar 

  36. 36.

    Parkkinen M, Lindahl J, Mäkinen TJ et al (2018) Predictors of osteoarthritis following operative treatment of medial tibial plateau fractures. Injury 49:370–375

    PubMed  Article  Google Scholar 

  37. 37.

    Dias JJ, Stirling AJ, Finlay DB, Gregg PJ (1987) Computerised axial tomography for tibial plateau fractures. J Bone Joint Surg Br 69:84–88

    CAS  PubMed  Article  Google Scholar 

  38. 38.

    Chan PS, Klimkiewicz JJ, Luchetti WT et al (1997) Impact of CT scan on treatment plan and fracture classification of tibial plateau fractures. J Orthop Trauma 11:484–489

    CAS  PubMed  Article  Google Scholar 

  39. 39.

    Wicky S, Blaser PF, Blanc CH et al (2000) Comparison between standard radiography and spiral CT with 3D reconstruction in the evaluation, classification and management of tibial plateau fractures. Eur Radiol 10:1227–1232

    CAS  PubMed  Article  PubMed Central  Google Scholar 

  40. 40.

    Charalambous CP, Tryfonidis M, Alvi F et al (2007) Inter- and intra-observer variation of the Schatzker and AO/OTA classifications of tibial plateau fractures and a proposal of a new classification system. Ann R Coll Surg Engl 89:400–404

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  41. 41.

    Mellema JJ, Doornberg JN, Molenaars RJ et al (2016) Interobserver reliability of the Schatzker and Luo classification systems for tibial plateau fractures. Injury 47:944–949

    PubMed  Article  Google Scholar 

  42. 42.

    Walton NP, Harish S, Roberts C, Blundell C (2003) AO or Schatzker? How reliable is classification of tibial plateau fractures? Arch Orthop Trauma Surg 123:396–398

    CAS  PubMed  Article  Google Scholar 

  43. 43.

    Zhu Y, Hu C-F, Yang G et al (2013) Inter-observer reliability assessment of the Schatzker, AO/OTA and three-column classification of tibial plateau fractures. J Trauma Manag Outcomes 7:7

    PubMed  PubMed Central  Article  Google Scholar 

  44. 44.

    Zeltser DW, Leopold SS (2013) Classifications in brief: Schatzker classification of tibial plateau fractures. Clin Orthop Relat Res 471:371–374

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Mary Kate Erdman.

Ethics declarations

Conflicts of interest

G. S. Marecek receives research support from BoneSupport AB, consulting fees from Globus Medical, Nuvasive, Stryker and Synthes and he is a committee member for the Orthopedic Trauma Association and Western Orthopedic Association. The remaining authors have nothing to disclose.

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

Erdman, M.K., Gibbs, S.J., Tucker, D.W. et al. Radiographic detection of lateral plateau involvement in medial tibial plateau fractures (AO/OTA 41-B1.2, 1.3, 3.2 and 3.3). Eur J Orthop Surg Traumatol (2021). https://doi.org/10.1007/s00590-021-03117-7

Download citation

Keywords

  • Tibial plateau
  • Medial plateau
  • Lateral extension