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      3D mapping and classification of tibial plateau fractures

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          Abstract

          Aims

          Tibial plateau fractures (TPFs) are complex injuries around the knee caused by high- or low-energy trauma. In the present study, we aimed to define the distribution and frequency of TPF lines using a 3D mapping technique and analyze the rationalization of divisions employed by frequently used classifications.

          Methods

          In total, 759 adult patients with 766 affected knees were retrospectively reviewed. The TPF fragments on CT were multiplanar reconstructed, and virtually reduced to match a 3D model of the proximal tibia. 3D heat mapping was subsequently created by graphically superimposing all fracture lines onto a tibia template.

          Results

          The cohort included 405 (53.4%) cases with left knee injuries, 347 (45.7%) cases with right knee injuries, and seven (0.9%) cases with bilateral injuries. On mapping, the hot zones of the fracture lines were mainly concentrated around the anterior cruciate ligament insertion, posterior cruciate ligament insertion, and the inner part of the lateral condyle that extended to the junctional zone between Gerdy’s tubercle and the tibial tubercle. Moreover, the cold zones were scattered in the posteromedial fragment, superior tibiofibular syndesmosis, Gerdy’s tubercle, and tibial tubercle. TPFs with different Orthopaedic Trauma Association/AO Foundation (OTA/AO) subtypes showed peculiar characteristics.

          Conclusion

          TPFs occurred more frequently in the lateral and intermedial column than in the medial column. Fracture lines of tibial plateau occur frequently in the transition zone with marked changes in cortical thickness. According to 3D mapping, the four-column and nine-segment classification had a high degree of matching as compared to the frequently used classifications.

          Cite this article: Bone Joint Res 2020;9(6):258–267.

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          Most cited references40

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          Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee.

          The purpose of this new classification compendium is to republish the Orthopaedic Trauma Association's (OTA) classification. The OTA classification was originally published in a compendium of the Journal of Orthopaedic Trauma in 1996. It adopted The Comprehensive Classification of the Long Bones developed by Müller and colleagues and classified the remaining bones. In this compendium, the introductory chapter reviews new scientific information about classifying fractures that has been published in the last 11 years. The classification is presented in a revised format that is easier to follow. The OTA and AO classification will now have a unified alpha-numeric code eliminating the differences that have existed between the 2 codes. The code was significantly revised for the clavicle and scapula, foot and hand, and patella. Dislocations have been expanded on an anatomic basis and for most joints will be coded separately. This publication should stimulate new developments and interest in a unified language to code and classify fractures. Further improvements in classification will result in better patient care and clinical research.
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            Revisiting the Schatzker classification of tibial plateau fractures

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              The pilon map: fracture lines and comminution zones in OTA/AO type 43C3 pilon fractures.

              The purpose of this investigation is to define the location and frequency of tibia pilon fracture lines and impaction injury for the most severe variety (OTA/AO type 43C3).
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                Author and article information

                Contributors
                Role: Associate Senior Doctor
                Role: Associate Senior Doctor
                Role: Resident Doctor
                Role: Associate Senior Doctor
                Role: Senior Doctor
                Role: Senior Inspector
                Role: Senior Doctor
                Role: Attending Doctor
                Journal
                Bone Joint Res
                Bone Joint Res
                bjr
                Bone & Joint Research
                The British Editorial Society of Bone and Joint Surgery (London )
                2046-3758
                23 July 2020
                June 2020
                : 9
                : 6
                : 258-267
                Affiliations
                [1 ]org-divisionDepartment of Orthopaedics, The Affiliated People’s Hospital of Jiangsu University , Zhenjiang, China
                [2 ]org-divisionJiangsu University Health Science Center , Zhenjiang, China
                [3 ]org-divisionDepartment of Orthopaedics, Tongji Hospital, Tongji University School of Medicine , Shanghai, China
                [4 ]org-divisionDepartment of Orthopaedics, Qingpu Branch of Zhongshan Hospital, Fudan University , Shanghai, China
                [5 ]org-divisionDepartment of Orthopaedics, the First Affilated Hospital of Soochow University , Soochow, China.
                Author notes
                Correspondence should be sent to Yingqi Zhang. E-mail: realzyq@ 123456163.com
                Article
                BJR-9-258
                10.1302/2046-3758.96.BJR-2019-0382.R2
                7376308
                32728424
                f7a49c46-442a-472e-bbfa-b0e84fc23636
                © 2020 Author(s) et al.

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited.

                History
                Categories
                Bone Biology
                bjr, BJR
                Custom metadata
                The Affiliated People’s Hospital of Jiangsu University, Zhenjiang, China

                tibial plateau fracture,3d mapping,fracture classification

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