Sagittal plane deformity in bicondylar tibial plateau fractures

Philipp N Streubel, Donald Glasgow, Ambrose Wong, David P. Barei, William M. Ricci, Michael J. Gardner

Research output: Contribution to journalReview article

13 Citations (Scopus)

Abstract

Objective: To evaluate the prevalence and magnitude of sagittal plane deformity in bicondylar tibial plateau fractures. Design: Retrospective radiographic review. Setting: Two Level I trauma centers. Main Outcome Measurement: Sagittal inclination of the medial and lateral plateau measured in relation to the longitudinal axis of the tibia using computed tomographic reconstruction images. Patients: Seventy-four patients (mean age, 49 years; range, 16-82 years; 64% male) with acute bicondylar tibial plateau fractures (Orthopaedic Trauma Association 41C, Schatzker VI) treated from October 2006 to July 2009. Results: The average sagittal plane angulation of the lateral plateau was 9.8° posteriorly (range, 17° anteriorly to 37° posteriorly). The medial plateau was angulated 4.1° posteriorly on average (range, 16° anteriorly to 31° posteriorly). Forty-two lateral plateaus were angulated more than 5° from the "normal" anatomic slope (defined as 5° of posterior tibial slope). Of these, 76% were angulated posteriorly. Forty-three (58%) of the medial plateaus were angulated greater than 5° from normal, of which only 47% were inclined posteriorly (P = 0.019 compared with lateral plateaus). In 68% of patients, the difference between medial and lateral plateaus was greater than 5°; the average intercondylar slope difference was 9° (range, 0°-31°; P < 0.001). Spanning external fixation did not affect the slope of either the medial or lateral tibial plateau. Intraobserver and interobserver correlations were high for both the medial and lateral plateaus (r 2 > 0.81, P < 0.01). Conclusions: Considerable sagittal plane deformity exists in the majority of bicondylar tibial plateau fractures. The lateral plateau has a higher propensity for sagittal angulation and tends to have increased posterior slope. Most patients have a substantial difference between the lateral and medial plateau slopes. The identification of this deformity allows for accurate preoperative planning and specific reduction maneuvers to restore anatomic alignment.

Original languageEnglish (US)
Pages (from-to)560-565
Number of pages6
JournalJournal of Orthopaedic Trauma
Volume25
Issue number9
DOIs
StatePublished - Sep 1 2011

Fingerprint

Tibial Fractures
Computer-Assisted Image Processing
Trauma Centers
Tibia
Orthopedics
Wounds and Injuries

Keywords

  • CT imaging
  • fracture deformity
  • malunion
  • tibial plateau fracture

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Sagittal plane deformity in bicondylar tibial plateau fractures. / Streubel, Philipp N; Glasgow, Donald; Wong, Ambrose; Barei, David P.; Ricci, William M.; Gardner, Michael J.

In: Journal of Orthopaedic Trauma, Vol. 25, No. 9, 01.09.2011, p. 560-565.

Research output: Contribution to journalReview article

Streubel, PN, Glasgow, D, Wong, A, Barei, DP, Ricci, WM & Gardner, MJ 2011, 'Sagittal plane deformity in bicondylar tibial plateau fractures', Journal of Orthopaedic Trauma, vol. 25, no. 9, pp. 560-565. https://doi.org/10.1097/BOT.0b013e318200971d
Streubel, Philipp N ; Glasgow, Donald ; Wong, Ambrose ; Barei, David P. ; Ricci, William M. ; Gardner, Michael J. / Sagittal plane deformity in bicondylar tibial plateau fractures. In: Journal of Orthopaedic Trauma. 2011 ; Vol. 25, No. 9. pp. 560-565.
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AU - Glasgow, Donald

AU - Wong, Ambrose

AU - Barei, David P.

AU - Ricci, William M.

AU - Gardner, Michael J.

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N2 - Objective: To evaluate the prevalence and magnitude of sagittal plane deformity in bicondylar tibial plateau fractures. Design: Retrospective radiographic review. Setting: Two Level I trauma centers. Main Outcome Measurement: Sagittal inclination of the medial and lateral plateau measured in relation to the longitudinal axis of the tibia using computed tomographic reconstruction images. Patients: Seventy-four patients (mean age, 49 years; range, 16-82 years; 64% male) with acute bicondylar tibial plateau fractures (Orthopaedic Trauma Association 41C, Schatzker VI) treated from October 2006 to July 2009. Results: The average sagittal plane angulation of the lateral plateau was 9.8° posteriorly (range, 17° anteriorly to 37° posteriorly). The medial plateau was angulated 4.1° posteriorly on average (range, 16° anteriorly to 31° posteriorly). Forty-two lateral plateaus were angulated more than 5° from the "normal" anatomic slope (defined as 5° of posterior tibial slope). Of these, 76% were angulated posteriorly. Forty-three (58%) of the medial plateaus were angulated greater than 5° from normal, of which only 47% were inclined posteriorly (P = 0.019 compared with lateral plateaus). In 68% of patients, the difference between medial and lateral plateaus was greater than 5°; the average intercondylar slope difference was 9° (range, 0°-31°; P < 0.001). Spanning external fixation did not affect the slope of either the medial or lateral tibial plateau. Intraobserver and interobserver correlations were high for both the medial and lateral plateaus (r 2 > 0.81, P < 0.01). Conclusions: Considerable sagittal plane deformity exists in the majority of bicondylar tibial plateau fractures. The lateral plateau has a higher propensity for sagittal angulation and tends to have increased posterior slope. Most patients have a substantial difference between the lateral and medial plateau slopes. The identification of this deformity allows for accurate preoperative planning and specific reduction maneuvers to restore anatomic alignment.

AB - Objective: To evaluate the prevalence and magnitude of sagittal plane deformity in bicondylar tibial plateau fractures. Design: Retrospective radiographic review. Setting: Two Level I trauma centers. Main Outcome Measurement: Sagittal inclination of the medial and lateral plateau measured in relation to the longitudinal axis of the tibia using computed tomographic reconstruction images. Patients: Seventy-four patients (mean age, 49 years; range, 16-82 years; 64% male) with acute bicondylar tibial plateau fractures (Orthopaedic Trauma Association 41C, Schatzker VI) treated from October 2006 to July 2009. Results: The average sagittal plane angulation of the lateral plateau was 9.8° posteriorly (range, 17° anteriorly to 37° posteriorly). The medial plateau was angulated 4.1° posteriorly on average (range, 16° anteriorly to 31° posteriorly). Forty-two lateral plateaus were angulated more than 5° from the "normal" anatomic slope (defined as 5° of posterior tibial slope). Of these, 76% were angulated posteriorly. Forty-three (58%) of the medial plateaus were angulated greater than 5° from normal, of which only 47% were inclined posteriorly (P = 0.019 compared with lateral plateaus). In 68% of patients, the difference between medial and lateral plateaus was greater than 5°; the average intercondylar slope difference was 9° (range, 0°-31°; P < 0.001). Spanning external fixation did not affect the slope of either the medial or lateral tibial plateau. Intraobserver and interobserver correlations were high for both the medial and lateral plateaus (r 2 > 0.81, P < 0.01). Conclusions: Considerable sagittal plane deformity exists in the majority of bicondylar tibial plateau fractures. The lateral plateau has a higher propensity for sagittal angulation and tends to have increased posterior slope. Most patients have a substantial difference between the lateral and medial plateau slopes. The identification of this deformity allows for accurate preoperative planning and specific reduction maneuvers to restore anatomic alignment.

KW - CT imaging

KW - fracture deformity

KW - malunion

KW - tibial plateau fracture

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