Research progress on hyperextension tibial plateau fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 ZHANG Shimin , HU Sunjun , DU Shouchao , MA Zhuo

Department of Orthopedics, Yangpu Hospital, Tongji University, Shanghai, 200090, P.R.China;

Corresponding author：

ZHANG Shimin, Email: shiminchang11@aliyun.com

Keywords：

Tibial plateau fractures; knee hyperextension injury; diagonal injury mechanism

DOI：

10.7507/1002-1892.201707070

Video：

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ObjectiveTo summarize the progress in the treatment of hyperextension tibial plateau fractures.MethodsRelated literature concerning hyperextension tibial plateau fractures was reviewed and analyzed in terms of injury mechanisms, clinical patterns, and treatment outcomes.ResultsHyperextension tibial plateau fractures is a specific type of hyperextension knee injuries, which is happened with the knee in over-extended position (<0°) and characterized by fracture and concomitant ligament injury. It can be classified into 4 patterns: marginal avulsion fractures, unicondylar anteromedial fractures, anterolateral fractures, and bicondylar fractures. The failure of structures occurs according to the diagonal injury mechanism characterized by anterior compression fractures and posterior tension ruptures. It is noted as a rule that a smaller anterior fragment is more likely to accompany by a posterior ligament rupture. Unicondylar anteromedial fracture pattern is caused by hyperextension varus mechanism and usually accompanied by posterolateral corner rupture. Bicondylar hyperextension injury is characterized by posterior metaphyseal cortical tension rupture, anterior articular depression, and reversed posterior slope.ConclusionCurrently there is no consensus on the treatment of hyperextension tibial plateau fractures. Further basic and clinical studies are needed.

Citation： ZHANG Shimin, HU Sunjun, DU Shouchao, MA Zhuo. Research progress on hyperextension tibial plateau fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(4): 495-500. doi: 10.7507/1002-1892.201707070 Copy

1.	罗从风, 胡承方, 高洪, 等. 基于CT的胫骨平台骨折的三柱分型. 中华创伤骨科杂志, 2009, 11(3): 201-205.
2.	Luo CF, Sun H, Zhang B, et al. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma, 2010, 24(11): 683-692.
3.	张世民, 姚勐炜, 张立智, 等. 胫骨平台双髁四象限骨折的切开复位内固定治疗近期疗效观察. 中国矫形外科杂志, 2013, 21(18): 1808-1815.
4.	Chang SM, Hu SJ, Zhang YQ, et al. A surgical protocol for bicondylar four-quadrant tibial plateau fractures. Int Orthop, 2014, 38(12): 2559-2564.
5.	胡孙君, 张世民, 张英琪, 等. 胫骨平台后外侧象限骨折手术入路的深层解剖及后外侧与后内侧比较. 中国临床解剖学杂志, 2015, 33(5): 497-501.
6.	屠永刚, 任绍东, 叶柏林, 等. 后外侧入路撬拨复位简单内固定治疗胫骨后外侧平台塌陷性骨折. 中国修复重建外科杂志, 2017, 31(7): 810-814.
7.	杨小海, 徐锋, 尹自飞, 等. 后外侧倒 L 形入路 3.5 mm T 形支撑钢板内固定治疗单纯后外侧胫骨平台骨折疗效研究. 中国修复重建外科杂志, 2017, 31(7): 815-819.
8.	颜冰珊, 尹望平, 张新潮, 等. Schatzker Ⅳ 型胫骨平台骨折手术疗效分析. 中国修复重建外科杂志, 2017, 31(11): 1305-1310.
9.	Fornalski S, McGarry MH, Csintalan RP, et al. Biomechanical and anatomical assessment after knee hyperextension injury. Am J Sports Med, 2008, 36(1): 80-84.
10.	Twaddle BC, Bidwell TA, Chapman JR. Knee dislocations: where are the lesions? A prospective evaluation of surgical findings in 63 cases. J Orthop Trauma, 2003, 17(3): 198-202.
11.	Dwyer T, Whelan D. Anatomical considerations in multi-ligament knee injury and surgery. J Knee Surg, 2012, 25(4): 263-274.
12.	Schenck RC Jr, Kovach IS, Agarwal A, et al. Cruciate injury patterns in knee hyperextension: a cadaveric model. Arthroscopy, 1999, 15(5): 489-495.
13.	Gottsegen CJ, Eyer BA, White EA, et al. Avulsion fractures of the knee: imaging findings and clinical significance. Radiographics, 2008, 28(6): 1755-1770.
14.	Sheehan SE, Khurana B, Gaviola G, et al. A biomechanical approach to interpreting magnetic resonance imaging of knee injuries. Magn Reson Imaging Clin N Am, 2014, 22(4): 621-648.
15.	Goldman AB, Pavlov H, Rubenstein D. The Segond fracture of the proximal tibia: a small avulsion that reflects major ligamentous damage. Am J Roentgenol, 1988, 151(6): 1163-1167.
16.	Claes S, Luyckx T, Vereecke E, et al. The Segond fracture: a bony injury of the anterolateral ligament of the knee. Arthroscopy, 2014, 30(11): 1475-1482.
17.	Peltola EK, Mustonen AO, Lindahl J, et al. Segond fracture combined with tibial plateau fracture. Am J Roentgenol, 2011, 197(6): W1101-1104.
18.	Hall FM, Hochman MG. Medial Segond-type fracture: cortical avulsion off the medial tibial plateau associated with tears of the posterior cruciate ligament and medial meniscus. Skeletal Radiol, 1997, 26(9): 553-555.
19.	Escobedo EM, Mills WJ, Hunter JC. The " reverse Segond” fracture: association with a tear of the posterior cruciate ligament and medial meniscus. Am J Roentgenol, 2002, 178(4): 979-983.
20.	Kose O, Ozyurek S, Turan A, et al. Reverse Segond fracture and associated knee injuries: A case report and review of 13 published cases. Acta Orthop Traumatol Turc, 2016, 50(5): 587-591.
21.	Chiba T, Sugita T, Onuma M, et al. Injuries to the posterolateral aspect of the knee accompanied by compression fracture of the anterior part of the medial tibial plateau. Arthroscopy, 2001, 17(6): 642-647.
22.	Cohen AP, King D, Gibbon AJ. Impingement fracture of the anteromedial tibial margin: a radiographic sign of combined posterolateral complex and posterior cruciate ligament disruption. Skeletal Radiol, 2001, 30(2): 114-116.
23.	Bennett DL, George MJ, El-Khoury GY, et al. Anterior rim tibial plateau fractures and posterolateral corner knee injury. Emerg Radiol, 2003, 10(2): 76-83.
24.	Yoo JH, Kim EH, Yim SJ, et al. A case of compression fracture of medial tibial plateau and medial femoral condyle combined with posterior cruciate ligament and posterolateral corner injury. Knee, 2009, 16(1): 83-86.
25.	Conesa X, Minguell J, Cortina J, et al. Fracture of the anteromedial tibial plateau associated with posterolateral complex injury: case study and literature review. J Knee Surg, 2013, 26(Suppl 1): S34-39.
26.	Chanasit P, Sa-Ngasoongsong P, Chanplakorn P, et al. Anteromedial marginal fracture of medial tibial plateau without significant knee ligamentous injury in hypermobility patient: a case report and review of literature. Orthop Rev (Pavia), 2013, 5(2): 56-58.
27.	Tomás-Hernández J, Monyart JM, Serra JT, et al. Large fracture of the anteromedial tibial plateau with isolated posterolateral knee corner injury: case series of an often missed unusual injury pattern. Injury, 2016, 47(Suppl 3): S35-S40.
28.	Firoozabadi R, Schneidkraut J, Beingessner D, et al. Hyperextension varus bicondylar tibial plateau fracture pattern: diagnosis and treatment strategies. J Orthop Trauma, 2016, 30(5): e152-e157.
29.	Gonzalez LJ, Lott A, Konda S, et al. The hyperextension tibial plateau fracture pattern: a predictor of poor outcome. J Orthop Trauma, 2017, 31(11): e369-e374.
30.	Wu K, Huang J, Lin J, et al. Diagnosis and treatment of anterior tibial plateau fracture-dislocation: a case series and literature review. J Knee Surg, 2017, 30(2): 114-120.

1. 罗从风, 胡承方, 高洪, 等. 基于CT的胫骨平台骨折的三柱分型. 中华创伤骨科杂志, 2009, 11(3): 201-205.
2. Luo CF, Sun H, Zhang B, et al. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma, 2010, 24(11): 683-692.
3. 张世民, 姚勐炜, 张立智, 等. 胫骨平台双髁四象限骨折的切开复位内固定治疗近期疗效观察. 中国矫形外科杂志, 2013, 21(18): 1808-1815.
4. Chang SM, Hu SJ, Zhang YQ, et al. A surgical protocol for bicondylar four-quadrant tibial plateau fractures. Int Orthop, 2014, 38(12): 2559-2564.
5. 胡孙君, 张世民, 张英琪, 等. 胫骨平台后外侧象限骨折手术入路的深层解剖及后外侧与后内侧比较. 中国临床解剖学杂志, 2015, 33(5): 497-501.
6. 屠永刚, 任绍东, 叶柏林, 等. 后外侧入路撬拨复位简单内固定治疗胫骨后外侧平台塌陷性骨折. 中国修复重建外科杂志, 2017, 31(7): 810-814.
7. 杨小海, 徐锋, 尹自飞, 等. 后外侧倒 L 形入路 3.5 mm T 形支撑钢板内固定治疗单纯后外侧胫骨平台骨折疗效研究. 中国修复重建外科杂志, 2017, 31(7): 815-819.
8. 颜冰珊, 尹望平, 张新潮, 等. Schatzker Ⅳ 型胫骨平台骨折手术疗效分析. 中国修复重建外科杂志, 2017, 31(11): 1305-1310.
9. Fornalski S, McGarry MH, Csintalan RP, et al. Biomechanical and anatomical assessment after knee hyperextension injury. Am J Sports Med, 2008, 36(1): 80-84.
10. Twaddle BC, Bidwell TA, Chapman JR. Knee dislocations: where are the lesions? A prospective evaluation of surgical findings in 63 cases. J Orthop Trauma, 2003, 17(3): 198-202.
11. Dwyer T, Whelan D. Anatomical considerations in multi-ligament knee injury and surgery. J Knee Surg, 2012, 25(4): 263-274.
12. Schenck RC Jr, Kovach IS, Agarwal A, et al. Cruciate injury patterns in knee hyperextension: a cadaveric model. Arthroscopy, 1999, 15(5): 489-495.
13. Gottsegen CJ, Eyer BA, White EA, et al. Avulsion fractures of the knee: imaging findings and clinical significance. Radiographics, 2008, 28(6): 1755-1770.
14. Sheehan SE, Khurana B, Gaviola G, et al. A biomechanical approach to interpreting magnetic resonance imaging of knee injuries. Magn Reson Imaging Clin N Am, 2014, 22(4): 621-648.
15. Goldman AB, Pavlov H, Rubenstein D. The Segond fracture of the proximal tibia: a small avulsion that reflects major ligamentous damage. Am J Roentgenol, 1988, 151(6): 1163-1167.
16. Claes S, Luyckx T, Vereecke E, et al. The Segond fracture: a bony injury of the anterolateral ligament of the knee. Arthroscopy, 2014, 30(11): 1475-1482.
17. Peltola EK, Mustonen AO, Lindahl J, et al. Segond fracture combined with tibial plateau fracture. Am J Roentgenol, 2011, 197(6): W1101-1104.
18. Hall FM, Hochman MG. Medial Segond-type fracture: cortical avulsion off the medial tibial plateau associated with tears of the posterior cruciate ligament and medial meniscus. Skeletal Radiol, 1997, 26(9): 553-555.
19. Escobedo EM, Mills WJ, Hunter JC. The " reverse Segond” fracture: association with a tear of the posterior cruciate ligament and medial meniscus. Am J Roentgenol, 2002, 178(4): 979-983.
20. Kose O, Ozyurek S, Turan A, et al. Reverse Segond fracture and associated knee injuries: A case report and review of 13 published cases. Acta Orthop Traumatol Turc, 2016, 50(5): 587-591.
21. Chiba T, Sugita T, Onuma M, et al. Injuries to the posterolateral aspect of the knee accompanied by compression fracture of the anterior part of the medial tibial plateau. Arthroscopy, 2001, 17(6): 642-647.
22. Cohen AP, King D, Gibbon AJ. Impingement fracture of the anteromedial tibial margin: a radiographic sign of combined posterolateral complex and posterior cruciate ligament disruption. Skeletal Radiol, 2001, 30(2): 114-116.
23. Bennett DL, George MJ, El-Khoury GY, et al. Anterior rim tibial plateau fractures and posterolateral corner knee injury. Emerg Radiol, 2003, 10(2): 76-83.
24. Yoo JH, Kim EH, Yim SJ, et al. A case of compression fracture of medial tibial plateau and medial femoral condyle combined with posterior cruciate ligament and posterolateral corner injury. Knee, 2009, 16(1): 83-86.
25. Conesa X, Minguell J, Cortina J, et al. Fracture of the anteromedial tibial plateau associated with posterolateral complex injury: case study and literature review. J Knee Surg, 2013, 26(Suppl 1): S34-39.
26. Chanasit P, Sa-Ngasoongsong P, Chanplakorn P, et al. Anteromedial marginal fracture of medial tibial plateau without significant knee ligamentous injury in hypermobility patient: a case report and review of literature. Orthop Rev (Pavia), 2013, 5(2): 56-58.
27. Tomás-Hernández J, Monyart JM, Serra JT, et al. Large fracture of the anteromedial tibial plateau with isolated posterolateral knee corner injury: case series of an often missed unusual injury pattern. Injury, 2016, 47(Suppl 3): S35-S40.
28. Firoozabadi R, Schneidkraut J, Beingessner D, et al. Hyperextension varus bicondylar tibial plateau fracture pattern: diagnosis and treatment strategies. J Orthop Trauma, 2016, 30(5): e152-e157.
29. Gonzalez LJ, Lott A, Konda S, et al. The hyperextension tibial plateau fracture pattern: a predictor of poor outcome. J Orthop Trauma, 2017, 31(11): e369-e374.
30. Wu K, Huang J, Lin J, et al. Diagnosis and treatment of anterior tibial plateau fracture-dislocation: a case series and literature review. J Knee Surg, 2017, 30(2): 114-120.

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