Evaluation of fracture line orientation in tibial plateau fractures and its relationship with treatment outcomes

The main objective of this study is to evaluate the fracture line closest to the coronal plane according to the axis of the frontal plane (coronal plane), to investigate the relationship between cases grouped on the basis of angle with the Schatzker, AO, 3-column classification, and to analyze the relationship between the coverage of the fracture line closest to the axis of the coronal plane and treatment outcomes. We evaluated 48 patients aged 18-80 years who had undergone surgical treatment in our clinic since January 2007 with a diagnosis of tibial plateau fracture and who had adequate and appropriate direct radiography and computed tomography (CT). Patients who had less than six months of follow-up, were diagnosed with a tibial plateau fracture and treated conservatively, were diagnosed with an open tibial plateau fracture on initial admission, and had an external fixator or the Ilizarov method used for definitive (permanent) treatment were excluded from the study. Demographics data of patients, Schatzker, AO and 3-column classifications, the angle of the fracture line closest to the axis of the coronal plane in tomography with the axis of the coronal plane, the screw crossing the fracture line, the number of threads and screw length, the extent of collapse in the joint, the inclination angle, the union, the angulation angle. Compliance of fixation in relation to fracture alignment, clinical and radiological scores were examined. In our study, 11 (22.9%) were female and 37 (77.1%) were male, aged between 18-72 (mean=43.8±13.7). Thirty-one (39.5%) of the patients were involved in traffic accidents, 13 (27.1%) in falls from height, 3 (6.2%) in falls, and one (2.1%) in blows. Of the fractures detected in the cases, 31 (64.6%) were in the right tibia and 17 (35.4%) were in the left tibia. While 46 (95.8%) of the fractures were closed, 2 (4.2%) were open. While no complication developed after surgery in 22 (45.8%) cases, at least one complication occurred in 26 (54.2%) cases. The most common complication was irritation of the plate screws. When the patients' KSKS scores were examined, 25 (52.0%) were classified as 8 excellent and 12 (25.0%) as good. Of the KSFS scores, 29 (60.4%) were excellent and 11 (22.9%) were good. Additionally, 19 (39.6%) Rasmussen scores were good and 13 (27.1%) were excellent. Fractures were categorized by 3 observers using the Schatzker, AO, 3- column, and angle-based grouping system. The study examined the correlation between observers and found that there is statistically significant agreement. The fracture line closest to the coronal plane was determined and measured by 3 observers on CT cross sections. Accordingly, cases were divided into 3 groups. Group 1 (0-30 degrees), group 2 (30-60 degrees), and group 3 (60- 90 degrees) were categorized. It was found that the cases classified as group 1 and group 2 were associated with severe fractures, and the cases in group 3 were associated with mild fractures. In addition, the clinical and radiological outcomes of the fractures in groups 1 and 2 were classified as poor. The number of screws crossing the coronal fracture line, the number of threads, and the screw length were measured by tomography. The number of screws crossing the fracture line was 3.4±1.5 (0-6), the number of threads was 43.3±23.3 (0-82), and the screw length was 12.4±6.3 (0-27). It was found that clinical and radiological results were better with increasing number of screws, threads and screw length. As a result, fractures in the coronal plane are usually posteromedially located, where they are more common in complex fractures. These fractures are more difficult to detect. The presence of these fractures and their approach to the coronal plane have a negative impact on clinical and radiological results. As the number of threads, screws, and screw lengths in the coronal plane increases, clinical and radiological outcomes are positively affected. We think that the anglebased grouping system formed by the fracture line closest to the coronal plane with the axis of the frontal (coronal) plane will contribute to the fracture orientation of surgeons.