Predictors of reduction loss in tibial plateau fracture surgery: Focusing on posterior coronal fractures

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• 作者：Chang-Wan Kim^a ; Chang-Rack Lee^a ; ^{leechangrack@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Ki-Chan An^a ; Heui-Chul Gwak^a ; Jung-Han Kim^a ; Lih Wang^b ; Dong-Gil Yoon^a
• 关键词：Tibial plateau fracture ; Reduction loss ; Coronal fracture ; Comminution
• 刊名：Injury
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：47
• 期：7
• 页码：1483-1487
• 全文大小：602 K

文摘

Some studies have reported that fracture pattern was associated with reduction loss after surgery. The purpose of this study was to evaluate various factors that can influence reduction loss, including fracture patterns in unicondylar and bicondylar tibial plateau fractures.

Materials and methods

A total of 138 tibial plateau fractures that underwent open reduction and internal fixation using plates were retrospectively reviewed. The OTA/AO classification, fracture pattern, degree of comminution, and existence of reduction loss were evaluated based on simple radiographs and computed tomography. Patient information, including age, gender, and occupation, were acquired through chart reviews. The effect of each variable on reduction loss was evaluated through multiple logistic regression analysis.

Results

Of 138 knees, reduction loss was observed in 40 knees (29.0%). Reduction loss was found in 11 (20.4%) of the type B knees (54 knees) and 29 (34.5%) of the type C knees (84 knees), according to the OTA/AO classification. The multiple logistic regression analysis for all cases revealed that the existence of comminution and coronal fracture influenced the occurrence of reduction loss, with odds ratios of 9.148 and 4.823, respectively (P < 0.001 and P = 0.001, respectively). In type B and type C, according to the OTA/AO classification, the existence of comminution and coronal fracture had causal relationships with the occurrence of reduction loss. The odds ratios of comminution and coronal fracture for reduction loss for type B were 9.114 and 9.117, respectively (P = 0.019 and P = 0.031, respectively), and the odds ratios for type C were 8.490 and 4.782, respectively (P = 0.001 and 0.009, respectively).

Conclusions

When a tibial plateau fracture has a coronal fracture, if it is difficult to fix its fragments rigidly with medial or lateral plate fixation; therefore, buttress plating or direct fixation of fragments through the posteromedial, posterolateral, or posterior approach should be considered.