Prediction of soft-tissue injuries in Schatzker II tibial plateau fractures based on measurements of plain radiographs

Michael J. Gardner, Shahan Yacoubian, David S. Geller, Matthew Pode, Douglas Mintz, David L. Helfet, Dean G. Lorich

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background: Split-depression fractures of the lateral tibial plateau (Schatzker II) are associated with a significant risk of capsuloligamentous and meniscal injury. We hypothesized that the amount of fracture depression and widening on anteroposterior (AP) plain radiographs would correlate with the incidence of injury to these structures on magnetic resonance imaging (MRI). Methods: Sixty-two consecutive patients with Schatzker II tibial plateau fractures had a knee x-ray series and MRI preoperatively. AP plain radiographs were measured for lateral joint line depression and condylar widening, and MRIs were evaluated for injury to soft-tissue structures around the knee. For each structure, the threshold of depression and widening that led to the greatest disparity in soft-tissue injury was determined. Multiple logistic regressions were applied to calculate whether depression and/or widening above the thresholds were predictive for injury to individual soft-tissue structures. Results: When depression was greater than 6 mm and widening was greater than 5 mm, lateral meniscal injury occurred in 83% of fractures, compared with 50% of fractures with less displacement (p < 0.05). When either depression or widening was at least 8 mm, medial meniscal injury occurred more frequently (depression 53%, p < 0.05; widening 78%, p < 0.05; versus neither 15%). Lateral collateral ligament and posterior cruciate ligament tears were not seen with minimally displaced fractures (< 4 mm), but the incidence of injury approached 30% with increasing displacement. Conclusions: Due to the limited availability of MRI in some centers, correlation of lateral condylar depression and widening, as measured on plain radiographs, to injury of various soft-tissue structures may be extremely helpful in planning open or arthroscopic treatment methods. Using these guidelines, Schatzker II fractures with depression or widening approaching 5 mm deserve heightened vigilance in diagnosing and treating these concomitant soft-tissue injuries.

Original languageEnglish (US)
Pages (from-to)319-324
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume60
Issue number2
DOIs
StatePublished - Feb 2006

Fingerprint

Soft Tissue Injuries
Tibial Fractures
Wounds and Injuries
Magnetic Resonance Imaging
Knee
Ankle Lateral Ligament
Posterior Cruciate Ligament
Incidence
Joints
Logistic Models
X-Rays
Guidelines

Keywords

  • Fracture
  • Magnetic resonance imaging
  • Meniscus
  • Schatzker II
  • Soft-tissue injury
  • Tibial plateau

ASJC Scopus subject areas

  • Surgery

Cite this

Prediction of soft-tissue injuries in Schatzker II tibial plateau fractures based on measurements of plain radiographs. / Gardner, Michael J.; Yacoubian, Shahan; Geller, David S.; Pode, Matthew; Mintz, Douglas; Helfet, David L.; Lorich, Dean G.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 60, No. 2, 02.2006, p. 319-324.

Research output: Contribution to journalArticle

Gardner, Michael J. ; Yacoubian, Shahan ; Geller, David S. ; Pode, Matthew ; Mintz, Douglas ; Helfet, David L. ; Lorich, Dean G. / Prediction of soft-tissue injuries in Schatzker II tibial plateau fractures based on measurements of plain radiographs. In: Journal of Trauma - Injury, Infection and Critical Care. 2006 ; Vol. 60, No. 2. pp. 319-324.
@article{56931e4d20044799914153a106ddc6d0,
title = "Prediction of soft-tissue injuries in Schatzker II tibial plateau fractures based on measurements of plain radiographs",
abstract = "Background: Split-depression fractures of the lateral tibial plateau (Schatzker II) are associated with a significant risk of capsuloligamentous and meniscal injury. We hypothesized that the amount of fracture depression and widening on anteroposterior (AP) plain radiographs would correlate with the incidence of injury to these structures on magnetic resonance imaging (MRI). Methods: Sixty-two consecutive patients with Schatzker II tibial plateau fractures had a knee x-ray series and MRI preoperatively. AP plain radiographs were measured for lateral joint line depression and condylar widening, and MRIs were evaluated for injury to soft-tissue structures around the knee. For each structure, the threshold of depression and widening that led to the greatest disparity in soft-tissue injury was determined. Multiple logistic regressions were applied to calculate whether depression and/or widening above the thresholds were predictive for injury to individual soft-tissue structures. Results: When depression was greater than 6 mm and widening was greater than 5 mm, lateral meniscal injury occurred in 83{\%} of fractures, compared with 50{\%} of fractures with less displacement (p < 0.05). When either depression or widening was at least 8 mm, medial meniscal injury occurred more frequently (depression 53{\%}, p < 0.05; widening 78{\%}, p < 0.05; versus neither 15{\%}). Lateral collateral ligament and posterior cruciate ligament tears were not seen with minimally displaced fractures (< 4 mm), but the incidence of injury approached 30{\%} with increasing displacement. Conclusions: Due to the limited availability of MRI in some centers, correlation of lateral condylar depression and widening, as measured on plain radiographs, to injury of various soft-tissue structures may be extremely helpful in planning open or arthroscopic treatment methods. Using these guidelines, Schatzker II fractures with depression or widening approaching 5 mm deserve heightened vigilance in diagnosing and treating these concomitant soft-tissue injuries.",
keywords = "Fracture, Magnetic resonance imaging, Meniscus, Schatzker II, Soft-tissue injury, Tibial plateau",
author = "Gardner, {Michael J.} and Shahan Yacoubian and Geller, {David S.} and Matthew Pode and Douglas Mintz and Helfet, {David L.} and Lorich, {Dean G.}",
year = "2006",
month = "2",
doi = "10.1097/01.ta.0000203548.50829.92",
language = "English (US)",
volume = "60",
pages = "319--324",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Prediction of soft-tissue injuries in Schatzker II tibial plateau fractures based on measurements of plain radiographs

AU - Gardner, Michael J.

AU - Yacoubian, Shahan

AU - Geller, David S.

AU - Pode, Matthew

AU - Mintz, Douglas

AU - Helfet, David L.

AU - Lorich, Dean G.

PY - 2006/2

Y1 - 2006/2

N2 - Background: Split-depression fractures of the lateral tibial plateau (Schatzker II) are associated with a significant risk of capsuloligamentous and meniscal injury. We hypothesized that the amount of fracture depression and widening on anteroposterior (AP) plain radiographs would correlate with the incidence of injury to these structures on magnetic resonance imaging (MRI). Methods: Sixty-two consecutive patients with Schatzker II tibial plateau fractures had a knee x-ray series and MRI preoperatively. AP plain radiographs were measured for lateral joint line depression and condylar widening, and MRIs were evaluated for injury to soft-tissue structures around the knee. For each structure, the threshold of depression and widening that led to the greatest disparity in soft-tissue injury was determined. Multiple logistic regressions were applied to calculate whether depression and/or widening above the thresholds were predictive for injury to individual soft-tissue structures. Results: When depression was greater than 6 mm and widening was greater than 5 mm, lateral meniscal injury occurred in 83% of fractures, compared with 50% of fractures with less displacement (p < 0.05). When either depression or widening was at least 8 mm, medial meniscal injury occurred more frequently (depression 53%, p < 0.05; widening 78%, p < 0.05; versus neither 15%). Lateral collateral ligament and posterior cruciate ligament tears were not seen with minimally displaced fractures (< 4 mm), but the incidence of injury approached 30% with increasing displacement. Conclusions: Due to the limited availability of MRI in some centers, correlation of lateral condylar depression and widening, as measured on plain radiographs, to injury of various soft-tissue structures may be extremely helpful in planning open or arthroscopic treatment methods. Using these guidelines, Schatzker II fractures with depression or widening approaching 5 mm deserve heightened vigilance in diagnosing and treating these concomitant soft-tissue injuries.

AB - Background: Split-depression fractures of the lateral tibial plateau (Schatzker II) are associated with a significant risk of capsuloligamentous and meniscal injury. We hypothesized that the amount of fracture depression and widening on anteroposterior (AP) plain radiographs would correlate with the incidence of injury to these structures on magnetic resonance imaging (MRI). Methods: Sixty-two consecutive patients with Schatzker II tibial plateau fractures had a knee x-ray series and MRI preoperatively. AP plain radiographs were measured for lateral joint line depression and condylar widening, and MRIs were evaluated for injury to soft-tissue structures around the knee. For each structure, the threshold of depression and widening that led to the greatest disparity in soft-tissue injury was determined. Multiple logistic regressions were applied to calculate whether depression and/or widening above the thresholds were predictive for injury to individual soft-tissue structures. Results: When depression was greater than 6 mm and widening was greater than 5 mm, lateral meniscal injury occurred in 83% of fractures, compared with 50% of fractures with less displacement (p < 0.05). When either depression or widening was at least 8 mm, medial meniscal injury occurred more frequently (depression 53%, p < 0.05; widening 78%, p < 0.05; versus neither 15%). Lateral collateral ligament and posterior cruciate ligament tears were not seen with minimally displaced fractures (< 4 mm), but the incidence of injury approached 30% with increasing displacement. Conclusions: Due to the limited availability of MRI in some centers, correlation of lateral condylar depression and widening, as measured on plain radiographs, to injury of various soft-tissue structures may be extremely helpful in planning open or arthroscopic treatment methods. Using these guidelines, Schatzker II fractures with depression or widening approaching 5 mm deserve heightened vigilance in diagnosing and treating these concomitant soft-tissue injuries.

KW - Fracture

KW - Magnetic resonance imaging

KW - Meniscus

KW - Schatzker II

KW - Soft-tissue injury

KW - Tibial plateau

UR - http://www.scopus.com/inward/record.url?scp=33646085368&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33646085368&partnerID=8YFLogxK

U2 - 10.1097/01.ta.0000203548.50829.92

DO - 10.1097/01.ta.0000203548.50829.92

M3 - Article

VL - 60

SP - 319

EP - 324

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 2

ER -