Research On Regularity Of Schatzker Type Ⅳ Tibial Plateau Fractures Associated With Injury To The Knee Ligament And Meniscus

Objective: To evaluate the characteristics and mechanism of the Schatzker type IV tibial plateau fractures associated with injury to the knee ligament and meniscus.Methods: From June 2016 to June 2020,39 patients with Schatzker type IV tibial plateau fracture who had been hospitalized in our department were enrolled in which 30 males and 9 females,with an average age of 40.4years(from 15 to 64 years).All the cases were further classified based on the Wahlquist classification.All the fractures of 39 patients were analyzed by MRI and Surgical findings to verify the injury of cruciate ligament,collateral ligament and meniscus.Then the relationship between the fracture pattern such as type A,B,and C and the soft tissue injury were furtherer evaluated.Results: The incidence of associated injuries to the knee ligment and meniscus was 74% in the Schatzker type IV tibial plateau fractures(29/39).The causes of associated injuries included traffic accident(12 cases),falling down(13 cases),sports(1 cases)and falling from a great height(3 cases).According to Wahlquist classification there were 4 cases of type A,7cases of type B and 18 cases of type C associated with soft tissue injury within 39 patients.Of 100 associated injuries in all 39 patients there were 22(56%)anterior cruciate ligament(ACL)injuries,17(44%)posterior cruciate ligament(PCL)injuries,10(25%)medial collateral ligament(MCL)injuries,18(46%)lateral collateral ligament(LCL)injuries,17(44%)medial meniscus(MM)tears and 16(41%)lateral meniscus(LM)tears.The incidences of each type A,B and C associated with soft tissue injuries were significant different(P <0.05),respectively.The difference of the incidences of ACL injuries,LCL injuries,MM tears and LM tears within type A,B and C were significant(P <0.05),respectively.There was no significant difference of the incidences of PCL injuries and MCL injuries within type A,B and C(P > 0.05).The incidences of soft tissue injury in the Schatzker type IV tibial plateau fractures caused by low-energy(falling down,sports)or high-energy(traffic accident,falling from a great height)were no significant difference(P > 0.05).Conclusions: Schatzker type IV tibial plateau fractures represented a high incidence of the knee ligament and meniscus injuries.The Wahlquist tibial plateau fracture patterns were closely related to the ACL injuries,LCL injuries and meniscus tears.Based on our data,the knee ligament and meniscus injuries in Schatzker type IV tibial plateau fractures should be paid more attention.MRI was necessary before surgery inorder to evaluate the soft tissue injury and the plan-making.