Prediction of Distal Tibial Articular Extension in Tibial Shaft Fractures
Category: Trauma; Ankle Introduction/Purpose: Diaphyseal tibial fractures account for approximately 1.9% of all adult fractures. A recent registry review in Finland found an annual incidence of 15.6 per 100,000 person-years in males and 11.5 per 100,000 person-years in women. There are several studi...
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| Veröffentlicht in: | Foot & ankle orthopaedics Jg. 7; H. 4 |
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| Hauptverfasser: | , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
| Veröffentlicht: |
Los Angeles, CA
SAGE Publications
01.11.2022
Sage Publications Ltd SAGE Publishing |
| Schlagworte: | |
| ISSN: | 2473-0114, 2473-0114 |
| Online-Zugang: | Volltext |
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| Zusammenfassung: | Category:
Trauma; Ankle
Introduction/Purpose:
Diaphyseal tibial fractures account for approximately 1.9% of all adult fractures. A recent registry review in Finland found an annual incidence of 15.6 per 100,000 person-years in males and 11.5 per 100,000 person-years in women. There are several studies which have demonstrated a high proportion of diaphyseal tibial fractures have ipsilateral occult posterior malleolus fractures, this ranges from 22-92.3%. Recent work by Hendrickx et al has highlighted distal third and spiral tibial shaft fracture patterns as independent predictors of occult posterior malleolus fracture.
Methods:
Objectives Our primary outcome in this study was to identify any factors that could predict articular extension in tibial shaft fractures. Study Design & Methods A retrospective review of a prospectively collected database was performed at Liverpool University Hospitals NH Foundation Trust between 1/1/2013 and 9/11/2020. The inclusion criteria were patients over the age of 16, with a diaphyseal tibial fracture and who underwent a CT of the affected lower limb. The articular fracture extension was categorised into either posterior malleolar (PM) or other fracture.
Results:
764 diaphyseal tibial fractures were analysed, of these 300 had a CT and could be included. There were 127 intra- articular fractures. Of these, 83 (65.4%) cases were PM and 44 were other fractures. On univariate analysis, the PM fractures were associated with fibular spiral (p=-016) fractures and no fracture of the fibular (p=.003), lateral direction of the tibial fracture (p=.04), female gender (p=.002), AO classification 42B1 (p=.033) and an increasing angle of tibial fracture. However, on multivariate regression analysis the only significant factor was a high angle of tibia fracture. Other distal tibia fracture extensions were associated with no fracture of the fibular (p=.002), medial direction of tibia fracture (p=.004), female gender (p=.000), and AO classification 42A1 (p=.004), 42A2 (p=.029), 42B3 (p=035) and 42C2 (p=.032). On multivariate analysis. the lateral direction of tibia fracture, and AO classification 42A1 and 42A2 were significant factors.
Conclusion:
Distal tibia articular extension occurs in almost half of tibial shaft fractures. A number of factors were associated with the extension, however multivariate analysis did not create a suitable prediction model. Nevertheless, rotational tibia fractures with a high angle of fracture should have a low threshold of further investigation with a CT prior to surgical intervention. |
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| Bibliographie: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 |
| ISSN: | 2473-0114 2473-0114 |
| DOI: | 10.1177/2473011421S00835 |