Anterior tibial plateau fracture: An often missed injury
Background In most classifcations of tibial plateau fractures, including one used most widely-Schatzker classifcation, fractures are described as a combination of medial and lateral condyle, primarily in the sagittal plane. Coronal component of these fractures, affecting the posterior tibial condyle...
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Published in | Indian journal of orthopaedics Vol. 48; no. 5; pp. 507 - 510 |
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Main Authors | , , |
Format | Journal Article |
Language | English |
Published |
New Delhi
Springer India
01.09.2014
Medknow Publications and Media Pvt. Ltd Medknow Publications & Media Pvt. Ltd Medknow Publications & Media Pvt Ltd |
Subjects | |
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Abstract | Background
In most classifcations of tibial plateau fractures, including one used most widely-Schatzker classifcation, fractures are described as a combination of medial and lateral condyle, primarily in the sagittal plane. Coronal component of these fractures, affecting the posterior tibial condyle is now well recognized. What is not described is anterior coronal component of the fracture, what we are calling “anterior tibial condyle fracture”. These fractures are often missed on routine antero-posterior and lateral knee X-rays due to an overlap between the fracture and the normal bone.
Materials and Methods
Eight cases of anterior tibial condyle fractures with posterior subluxation of the tibia, six of which were missed by the initial surgeon and two referred to us early, are described. Two of the six late cases and both the early ones were operated. Reconstruction of the anterior condyle and posterior cruciate ligament reconstruction was done. Primary outcome measures such as union of the fracture, residual fexion deformity, range of motion and stability were studied at the end of 6 months.
Results
All operated fractures united. There was no posterior sag in any. In those presenting late and were operated, the fexion deformity got corrected in all (average from 15° to 0°) and mean fexion achieved was 100° (range: 80-120°). In those presenting early and were operated, there was no fexion deformity at 6 months and a mean fexion achieved was 115° (range: 100-130°). None of the operated patients had instability.
Conclusion
This article attempts to highlight that this injury is often missed. They should be suspected, diagnosed early and treated by reconstruction of anterior condyle, posterior cruciate ligament reconstruction. |
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AbstractList | In most classifications of tibial plateau fractures, including one used most widely-Schatzker classification, fractures are described as a combination of medial and lateral condyle, primarily in the sagittal plane. Coronal component of these fractures, affecting the posterior tibial condyle is now well recognized. What is not described is anterior coronal component of the fracture, what we are calling "anterior tibial condyle fracture". These fractures are often missed on routine antero-posterior and lateral knee X-rays due to an overlap between the fracture and the normal bone.
Eight cases of anterior tibial condyle fractures with posterior subluxation of the tibia, six of which were missed by the initial surgeon and two referred to us early, are described. Two of the six late cases and both the early ones were operated. Reconstruction of the anterior condyle and posterior cruciate ligament reconstruction was done. Primary outcome measures such as union of the fracture, residual flexion deformity, range of motion and stability were studied at the end of 6 months.
All operated fractures united. There was no posterior sag in any. In those presenting late and were operated, the flexion deformity got corrected in all (average from 15° to 0°) and mean flexion achieved was 100° (range: 80-120°). In those presenting early and were operated, there was no flexion deformity at 6 months and a mean flexion achieved was 115° (range: 100-130°). None of the operated patients had instability.
This article attempts to highlight that this injury is often missed. They should be suspected, diagnosed early and treated by reconstruction of anterior condyle, posterior cruciate ligament reconstruction. BACKGROUNDIn most classifications of tibial plateau fractures, including one used most widely-Schatzker classification, fractures are described as a combination of medial and lateral condyle, primarily in the sagittal plane. Coronal component of these fractures, affecting the posterior tibial condyle is now well recognized. What is not described is anterior coronal component of the fracture, what we are calling "anterior tibial condyle fracture". These fractures are often missed on routine antero-posterior and lateral knee X-rays due to an overlap between the fracture and the normal bone. MATERIALS AND METHODSEight cases of anterior tibial condyle fractures with posterior subluxation of the tibia, six of which were missed by the initial surgeon and two referred to us early, are described. Two of the six late cases and both the early ones were operated. Reconstruction of the anterior condyle and posterior cruciate ligament reconstruction was done. Primary outcome measures such as union of the fracture, residual flexion deformity, range of motion and stability were studied at the end of 6 months. RESULTSAll operated fractures united. There was no posterior sag in any. In those presenting late and were operated, the flexion deformity got corrected in all (average from 15° to 0°) and mean flexion achieved was 100° (range: 80-120°). In those presenting early and were operated, there was no flexion deformity at 6 months and a mean flexion achieved was 115° (range: 100-130°). None of the operated patients had instability. CONCLUSIONThis article attempts to highlight that this injury is often missed. They should be suspected, diagnosed early and treated by reconstruction of anterior condyle, posterior cruciate ligament reconstruction. Background: In most classifications of tibial plateau fractures, including one used most widely-Schatzker classification, fractures are described as a combination of medial and lateral condyle, primarily in the sagittal plane. Coronal component of these fractures, affecting the posterior tibial condyle is now well recognized. What is not described is anterior coronal component of the fracture, what we are calling "anterior tibial condyle fracture". These fractures are often missed on routine antero-posterior and lateral knee X-rays due to an overlap between the fracture and the normal bone. Materials and Methods: Eight cases of anterior tibial condyle fractures with posterior subluxation of the tibia, six of which were missed by the initial surgeon and two referred to us early, are described. Two of the six late cases and both the early ones were operated. Reconstruction of the anterior condyle and posterior cruciate ligament reconstruction was done. Primary outcome measures such as union of the fracture, residual flexion deformity, range of motion and stability were studied at the end of 6 months. Results: All operated fractures united. There was no posterior sag in any. In those presenting late and were operated, the flexion deformity got corrected in all (average from 15 to 0) and mean flexion achieved was 100 (range: 80-120). In those presenting early and were operated, there was no flexion deformity at 6 months and a mean flexion achieved was 115 (range: 100-130). None of the operated patients had instability. Conclusion: This article attempts to highlight that this injury is often missed. They should be suspected, diagnosed early and treated by reconstruction of anterior condyle, posterior cruciate ligament reconstruction. Background In most classifcations of tibial plateau fractures, including one used most widely-Schatzker classifcation, fractures are described as a combination of medial and lateral condyle, primarily in the sagittal plane. Coronal component of these fractures, affecting the posterior tibial condyle is now well recognized. What is not described is anterior coronal component of the fracture, what we are calling “anterior tibial condyle fracture”. These fractures are often missed on routine antero-posterior and lateral knee X-rays due to an overlap between the fracture and the normal bone. Materials and Methods Eight cases of anterior tibial condyle fractures with posterior subluxation of the tibia, six of which were missed by the initial surgeon and two referred to us early, are described. Two of the six late cases and both the early ones were operated. Reconstruction of the anterior condyle and posterior cruciate ligament reconstruction was done. Primary outcome measures such as union of the fracture, residual fexion deformity, range of motion and stability were studied at the end of 6 months. Results All operated fractures united. There was no posterior sag in any. In those presenting late and were operated, the fexion deformity got corrected in all (average from 15° to 0°) and mean fexion achieved was 100° (range: 80-120°). In those presenting early and were operated, there was no fexion deformity at 6 months and a mean fexion achieved was 115° (range: 100-130°). None of the operated patients had instability. Conclusion This article attempts to highlight that this injury is often missed. They should be suspected, diagnosed early and treated by reconstruction of anterior condyle, posterior cruciate ligament reconstruction. |
Audience | Academic |
Author | Mhaskar, Vikram Arun Maheshwari, Jitendra Pandey, Vinay Kumar |
AuthorAffiliation | 1 Kalyani Knee and Shoulder Clinic, Varanasi, India Knee and Shoulder Clinic, New Delhi, India |
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BackLink | https://www.ncbi.nlm.nih.gov/pubmed/25298560$$D View this record in MEDLINE/PubMed |
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Cites_doi | 10.1097/BOT.0b013e3181d436f3 10.1007/s001130050218 10.1097/00005131-200502000-00001 10.1007/s10140-003-0298-z 10.1007/s002560000309 10.1097/01.bot.0000180369.24416.28 10.1097/00003086-198105000-00015 |
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Keywords | Fracture tibial plateau fracture tibial fractures cruciate ligament posterior subluxation tibia Anterior tibial condyle fracture |
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References_xml | – volume: 24 start-page: 683 year: 2010 end-page: 92 ident: CR6 article-title: Three-column fixation for complex tibial plateau fractures publication-title: J Orthop Trauma doi: 10.1097/BOT.0b013e3181d436f3 contributor: fullname: Zeng – volume: 100 start-page: 957 year: 1997 end-page: 67 ident: CR5 article-title: Particular posteromedial and posterolateral approaches for the treatment of tibial head fractures publication-title: Unfallchirurg doi: 10.1007/s001130050218 contributor: fullname: Tscheme – volume: 138 start-page: 94 year: 1979 end-page: 104 ident: CR1 article-title: The tibial plateau fracture. The Toronto experience 1968–1975 publication-title: Clin Orthop Relat Res contributor: fullname: Bruce – volume: 19 start-page: 73 year: 2005 end-page: 8 ident: CR3 article-title: Posterior bicondylar tibial plateau fractures publication-title: J Orthop Trauma doi: 10.1097/00005131-200502000-00001 contributor: fullname: Carlson – volume: 10 start-page: 76 year: 2003 end-page: 83 ident: CR7 article-title: Anterior rim tibial plateau fractures and posterolateral corner knee injury publication-title: Emerg Radiol doi: 10.1007/s10140-003-0298-z contributor: fullname: Sundaram – volume: 156 start-page: 128 year: 1981 end-page: 40 ident: CR4 article-title: Fracture-Dislocation of the knee publication-title: Clin Orthop Relat Res contributor: fullname: Moore – volume: 30 start-page: 114 year: 2001 end-page: 6 ident: CR8 article-title: Impingement fracture of the anteromedial tibial margin: A radiographic sign of combined posterolateral complex and posterior cruciate ligament disruption publication-title: Skeletal Radiol doi: 10.1007/s002560000309 contributor: fullname: Gibbon – volume: 19 start-page: 305 year: 2005 end-page: 10 ident: CR2 article-title: The posterior shearing tibial plateau fracture: Treatment and results via a posterior approach publication-title: J Orthop Trauma doi: 10.1097/01.bot.0000180369.24416.28 contributor: fullname: Vrahas – volume: 10 start-page: 76 year: 2003 ident: 4805507_CR7 publication-title: Emerg Radiol doi: 10.1007/s10140-003-0298-z contributor: fullname: DL Bennett – volume: 30 start-page: 114 year: 2001 ident: 4805507_CR8 publication-title: Skeletal Radiol doi: 10.1007/s002560000309 contributor: fullname: AP Cohen – volume: 19 start-page: 305 year: 2005 ident: 4805507_CR2 publication-title: J Orthop Trauma doi: 10.1097/01.bot.0000180369.24416.28 contributor: fullname: T Bhattacharyya – volume: 24 start-page: 683 year: 2010 ident: 4805507_CR6 publication-title: J Orthop Trauma doi: 10.1097/BOT.0b013e3181d436f3 contributor: fullname: CF Luo – volume: 19 start-page: 73 year: 2005 ident: 4805507_CR3 publication-title: J Orthop Trauma doi: 10.1097/00005131-200502000-00001 contributor: fullname: DA Carlson – volume: 156 start-page: 128 year: 1981 ident: 4805507_CR4 publication-title: Clin Orthop Relat Res doi: 10.1097/00003086-198105000-00015 contributor: fullname: TM Moore – volume: 100 start-page: 957 year: 1997 ident: 4805507_CR5 publication-title: Unfallchirurg doi: 10.1007/s001130050218 contributor: fullname: P Lobenhoffer – volume: 138 start-page: 94 year: 1979 ident: 4805507_CR1 publication-title: Clin Orthop Relat Res contributor: fullname: J Schatzker |
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Snippet | Background
In most classifcations of tibial plateau fractures, including one used most widely-Schatzker classifcation, fractures are described as a combination... In most classifications of tibial plateau fractures, including one used most widely-Schatzker classification, fractures are described as a combination of... Background: In most classifications of tibial plateau fractures, including one used most widely-Schatzker classification, fractures are described as a... BACKGROUNDIn most classifications of tibial plateau fractures, including one used most widely-Schatzker classification, fractures are described as a... |
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SubjectTerms | Conservative Orthopedics English literature Fractures Knee Ligaments Medical imaging Medicine & Public Health Original Original Article Orthopedics Skin & tissue grafts Sports injuries Surgery Surgical Orthopedics |
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Title | Anterior tibial plateau fracture: An often missed injury |
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