A study on injury mechanism of tibial plateau Hoffa fracture
10.3760/cma.j.cn115530-20201002-00641
- VernacularTitle:胫骨平台Hoffa骨折损伤机制的初步研究
- Author:
Yanbin ZHU
1
;
Wei CHEN
;
Kai DING
;
Haicheng WANG
;
Junyong LI
;
Tengbo YU
;
Qicai LI
;
Tianrui WANG
;
Zhanle ZHENG
;
Zhiyong HOU
;
Yingze ZHANG
Author Information
1. 河北医科大学第三医院创伤急救中心，河北省骨科研究所，河北省骨科生物力学重点实验室，石家庄 050051
- From:
Chinese Journal of Orthopaedic Trauma
2020;22(10):897-900
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To understand and verify the biomechanical mechanism of tibial plateau Hoffa (coronal) fracture by simulating high-altitude falls and traffic injuries using knee joint specimens.Methods:Ten specimens of lower limb knee joint were used. They were from 6 males and 4 females, with an average age of 57.4 years (from 42 to 65 years). They were divided into 2 equal groups: one subjected to simulation of high-altitude falls (fall group) and the other to simulation of traffic injury (traffic injury group). After injury simulation, standard orthographic and lateral X-ray examinations and CT scans were performed of the knee joints in the extended position to observe whether there was a fracture, where the fracture occurred, and how the fracture line went.Results:A tibial plateau coronal fracture was successfully simulated in 6 cases, but not in the other 4 cases. The failure was attributed to femoral fractures and other types of tibial plateau fracture. In the 3 successful fractures simulated by high-altitude fall, the fracture line was located all on the posterior medial side, involving the posterior 1/3, 2/5, and 1/2 of the tibial plateau, respectively. The fracture line and the coronal plane formed angles of 21°, 19° and 12°, respectively. The fracture was not shown on X-ray film in one case which was a posterior medial fracture on CT. In the other 3 successful fractures simulated by traffic injury, the fracture line involved 1/6, 1/4 and 1/3 of the posterior tibial plateau, respectively. The angles between the fracture line and the coronal plane were 47°, 56° and 63°, respectively. One case showed no obvious fracture signs on the X-ray but a coronal fracture on CT.Conclusions:This study has confirmed for the first time that both high-altitude falls and traffic injuries can cause coronal fractures of the tibial plateau which vary significantly in the extent of involvement and morphology. X-rays are not sufficient to fully diagnose this type of fractures, suggesting that patients with a clear history of knee flexion or axial violence injury should be routinely scanned by CT to reduce risks of missed diagnosis and insufficient treatment.
