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. 2019 Feb 26;20(1):12.
doi: 10.1186/s10195-019-0519-1.

Tibia plateau fracture mapping and its influence on fracture fixation

Lorcan McGonagle  1 , Tim Cordier  2 , Bjorn C Link  3 , Mark S Rickman  2 , Lucian B Solomon  2   4
Affiliations

Tibia plateau fracture mapping and its influence on fracture fixation

Lorcan McGonagle et al. J Orthop Traumatol. .

Abstract

Background: Tibial plateau fracture classifications are based on anteroposterior radiographs. Precontoured locking plates are commonly used to treat such fractures. The aims of this study are to: (1) describe tibial plateau fracture anatomy in the axial plane and (2) assess whether current plating systems allow screws to be placed suitably.

Materials and methods: A graphical tibial plateau template was developed. One hundred twenty-five tibial plateau fractures (four bilateral) were reviewed (80 men, 41 women; average age 45.5 years, range 21-77.7 years). The axial computed tomography (CT) slice 0.3-0.5 mm below the medial articular surface was reviewed in all cases. Fracture lines were drawn on the template. Four lateral locking plates were placed against a cadaveric adult tibia. Based on the projected screw directions, suitable fracture patterns were identified. Fractures were considered "suitable" if the screws passed 90 ± 22° to the fracture line.

Results: Two hundred sixty-one different fracture lines were identified. One hundred thirty-four fractures involved the lateral plateau; 96 were suitable for lateral plating. Ninety fractures involved the medial plateau, 82 were treatable using the various plate positions on medial-posterior aspect of the medial plateau. Thirty-seven fractures were bicondylar; 20 were treatable with a posteromedial plate.

Conclusions: Tibial plateau fractures follow consistent patterns, with most lateral and medial plateau fracture lines being in the sagittal plane, although there is greater variation medially. Positioning of modern locking plates will deal effectively with 72 % of all lateral plateau fractures and 91 % of medial plateau fractures.

Level of evidence: Level 3.

Keywords: Fixation; Fracture; Plateau; Tibia.

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Figures

Fig. 1
Fig. 1
Apical view of locking plate placed against tibia (Zimmer NCB proximal tibia system)
Fig. 2
Fig. 2
Lateral view of locking plate placed against cadaveric tibia (Zimmer NCB proximal tibia system)
Fig. 3
Fig. 3
Potential medial plateau plate positions (3.5-mm LCP posteromedial proximal tibia plate, Synthes technique guide)
Fig. 4
Fig. 4
Superimposition of all fracture lines onto one template
Fig. 5
Fig. 5
Lateral plateau fractures
Fig. 6
Fig. 6
Medial plateau fractures
Fig. 7
Fig. 7
Bicondylar fractures
See this image and copyright information in PMC

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