2017 ISAKOS Biennial Congress ePoster #1625

 

Routine Use Of Magnetic Resonance Imaging In Tibial Plateau Fractures. Does It Change The Surgical Approach?

Maximiliano Scheu, MD, MMSc, Santiago CHILE
Daniel Paccot, MD, Santiago, RM CHILE
Guillermo Izquierdo, MD, Santiago CHILE
Diego Montenegro, MD, Santiago CHILE
Carola Mellado, MD,, Santiago, region metropolitana CHILE
Gonzalo Espinoza, MD, Vitacura, Santiago CHILE

Hospital ClĂ­nico Mutual de Seguridad, santiago, region metropolitana, CHILE

FDA Status Not Applicable

Summary

Despite the high frequency of soft tissue injuries detected by MRI in tibial plateau fractures, surgical approach is rarely changed in the acute setting. The clinical impact of addressing soft tissue injuries in tibial plateau fractures needs to be further investigated

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Abstract

Background

Tibial plateau fractures are complex injuries associated with high incidence of meniscal and ligament injury. Magnetic resonance imaging (MRI) provides relevant information regarding soft-tissue injuries, however the routine use and clinical relevance of MRI is still matter of controversy.
The aim of this study is to evaluate if the information given by MRI changes surgical planning and what kind of soft tissue injuries the surgeon may resolve in the acute setting.

Methods

Retrospective study of a case series of patients with diagnosis of tibial plateau fracture admitted to a level I trauma center between January 2010 and November 2015 and managed with surgery. Patients with previous knee surgery or without MRI were excluded.
MRI images of soft tissue injuries were assessed by trained musculoskeletal radiologists. Among soft tissue injuries, meniscal tears, meniscal entrapment, extensor mechanism injuries, complete ligament disruptions, and full thickness femoral cartilage injuries were determined. Information regarding surgical procedures on soft tissue injuries was obtained from surgical protocols using medical records. Frequency was described using percentages.

Results

A total of 122 patients were included in this study: 101 men (82%) and 22 women (18%). The mean age was 44.5 years (range 20-71). The incidence of soft tissue injury was 73.8%; 74 patients (60.6%) had at least one ligament injury and 62 (51.6%) had at least one meniscal injury. Full thickness cartilage injury was found in 11 patients (9%) and subtotal distal patellar tendon avulsion was found in 1 patient (1,1%). In 6 out of 90 patients (6.7%) soft tissue injuries were repaired acutely; a Subtotal patellar tendon tear, a Flipped meniscus, Complete radial tear of the lateral meniscus (2 cases), a Medial collateral ligament distal avulsion (Stenner injury) and a lateral collateral ligament detachment. No ligamentary reconstructions were performed acutely. Among the remaining patients 4 out of 84 (4.8%) underwent surgery afterwards because of significant pain/instability, attributable to soft tissue injuries.

Conclusions

Despite the high frequency of soft tissue injuries detected by MRI in tibial plateau fractures, surgical approach is rarely changed in the acute setting. The clinical impact of routinary use of MRI in tibial plateau fractures needs to be further investigated.