Magnetic resonance imaging analysis of soft tissue injury associated with tibial plateau fractures: a prospective epidemiological study

SUN Ping; FU Shi-ping

doi:10.3760/cma.j.issn.1673-4777.2010.03.022

Abstract：Objective To observe the incidence and epidemiology of soft tissue structure injuries in tibial plateau fractures. Methods This study was designed as a prospective cohort research. The patients who suffered from tibial pleatu fractures and indicated for operative intervention were collected in the past four years. Standard x-ray examinations, including anteroposterior andlateral views, were performed in the emergency department. Subse-quently all patients were examined by magnetic resonance imaging (MRI). The Schatzker classifications were used to classify each fracture pattern based on the x-rays. Soft tissue injuries were assessed by MRI. with MRI, sixteen categories of injury in four important structures (including the cruciates, collateral ligaments, menisci, and postero-lateral corner) were determined as positive or negative. Results The overall incidence of injury to soft tissues was higher than previously reported. No patient had complete absence of any soft tissue injury. Sixty-eight patients (78.2%) had evidence of lateral meniscus pathology. Forty patients (46.0%) had medial meniscus tears. Sixty-one patients (70.1%) sustained a complete tear or avulsion of anterior cruciate and thirty-five (40.2%) had a pos-terior cruciate injury. Sixty-six (75.9%) suffered from partial or complete avulsion of lateral collateral ligament. 80 (92.0%) had medial collateral ligament injury Sixty-four patients (73.6%) had tears of 1 or more of the postero-lateral corner structures of the knee. The most frequent fracture pattern was a lateral plateau split-depression (Schatzker Ⅱ) (41.4%). The incidences of high-energy pattern fractures (Schatzker Ⅴ, Ⅴ, Ⅵ) were respec-tively 12.6%, 16. 1% and 13.8%. Pure depression injuries (Schatzker Ⅲ) were seen in 5.7% patients.Conclusions The incidence of complete ligamentous or meniscal disruption associated with operative tibial plateau fractures is higher than previously reported. Although the clinical importance of injury to each of these structures is unknown, surgeon should be aware that a variety of soft tissue injuries are common in these fractures. In addition,pure depression patterns can exist.