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Classification and morphology of hyperextension tibial plateau fracture

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Abstract

Purpose

This study was aimed at analyzing the incidence and characteristics of hyperextension tibial plateau fractures (HTPFs) by using a computed tomography (CT)–based “four-column and nine-segment” classification.

Methods

In the coronal plane, HTPFs are divided into four types: pure hyperextension, hyperextension–varus, hyperextension–valgus, and hyperextension–bicondylar. Fractures in the sagittal plane were divided into three types: type 1, pure depression; type 2, cleavage extending to the posterior cortex with no displacement; and type 3, cleavage extending to the posterior cortex with a significant displacement. A retrospective analysis of CT images of the tibial plateau fractures from December 2007 to December 2021 was conducted. Fracture mapping was analyzed and drawn using the new classification system.

Results

A total of 136 (10.9%, 136/1253) fractures fulfilled the radiographic criteria for HTPF pattern in 136 knees (53.5 ± 13.3 years). There were 11 knees with pure hyperextension fracture (8.1%), 23 with hyperextension–varus fracture (16.9%), 46 with hyperextension–valgus fracture (33.8%), and 56 with hyperextension–bicondylar fracture (41.2%) in the coronal plane. Furthermore, there were 64 (47.1%), 47 (34.6%), and 25 (18.4%) cases of type 1, type 2, and type 3 fractures, respectively, in the sagittal plane. In the three-dimensional heat map, the fracture lines were mainly located at the anterior rim of the tibial plateau, while the posterior articular surface was rarely involved.

Conclusions

The main manifestations of HTPF are anterior compression and posterior avulsion injury. The CT-based four-column and nine-segment classification system could be used to categorize the injury characteristics of HTPF in the coronal and sagittal planes.

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Acknowledgements

We thank Prof. Yingqi Zhang (3D map technology), Jiajun Zhao, Congfeng Luo (Fig. 7), Yu Zhan, and Yajun Shao for the selfless sharing of figures.

Funding

This work was supported by the Zhenjiang Science & Technology Program (Grant Number: SH2021034) and 江苏省高层次卫生人才 “六个一工程”拔尖人才科研项目 (Grant Number: LGY2020062). X. Yao reports institutional grants (paid to The Affiliated People’s Hospital of Jiangsu University) from the Zhenjiang Science & Technology Program (Grant Number: SH2021034) and 江苏省高层次卫生人才 “六个一工程”拔尖人才科研项目 (Grant Number: LGY2020062), all related to this study.

Author information

Author notes

  1. Xiang Yao and Minjie Hu contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopaedics, The Affiliated People’s Hospital of Jiangsu University, Zhenjiang, Jiangsu, China

    Xiang Yao, Minjie Hu, Hongyuan Liu & Jishan Yuan

  2. Jiangsu University, Zhenjiang, Jiangsu, China

    Minjie Hu & Hongyuan Liu

  3. Department of Orthopaedics, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China

    Jilei Tang

  4. Department of Orthopaedics, Qidong Hospital of Traditional Chinese Medicine, Nantong, Jiangsu, China, 226200

    Kaihua Zhou

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  1. Xiang Yao
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Contributions

X. Yao: Wrote the original draft of the manuscript, performed the methodology, acquired the funding.

M. Hu: Curated the data, acquired the software, and wrote, edited, and reviewed the manuscript.

H. Liu: Curated the data.

J. Tang: Performed the visualization.

J. Yuan: Carried out the project administration.

K. Zhou: Conceptualized the study.

Xiang Yao and Minjie Hu contributed equally to this work.

Corresponding authors

Correspondence to Jilei Tang, Jishan Yuan or Kaihua Zhou.

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No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Ethical review statement

This retrospective study has been approved by the ethical committee of the Affiliated People’s Hospital of Jiangsu University (K-20210041-Y).

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The authors declare no competing interests.

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Yao, X., Hu, M., Liu, H. et al. Classification and morphology of hyperextension tibial plateau fracture. International Orthopaedics (SICOT) 46, 2373–2383 (2022). https://doi.org/10.1007/s00264-022-05499-7

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  • DOI: https://doi.org/10.1007/s00264-022-05499-7

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