Importance of Proximal Tibiofibular Joint in Tibial Plateau Fractures - A Demographic Study

Background: The role of the proximal tibiofibular joint (PTFJ) in tibial plateau fractures is unknown. There is scarce data about its prevalence, and importance at the moment of assessing and deciding treatment or rehabilitation of these fractures.

The purpose of this study is to determine the prevalence of PTFJ and describe the demographics of these patients.

Methods: A retrospective cohort of adults with non-pathological tibial plateau fractures, who were treated surgically at Hadassah Medical Center from 2006 to 2018, was assessed. Radiographs of these patients were evaluated, searching for compromise of the PTFJ, final treatment, medial proximal tibial angle (MPTA), tibial slope angle and classified according Schazker. Finally demographic data was extracted from the clinical records.

Results: Of the 285 patients, with tibial plateau fractures 92(32%) were high-energy. PTFJ was injured in 73(25%) patients of whom 49(67%) were high energy. Compromise of PTFJ was present in 52% of high-energy fractures, especially in Schatzker VI type fractures(53%). There was a high tendency to use lateral plate o double plating in theses patients, only two were treated using a medial plate. None of the patient’s received operative treatment for the PTFJ injury. Average MPTA in patients with PTFJ injury angle was 89.7 º and tibial slopeMPTAbial slope angleTFJ injury7ºbial angle wasbial plateu frectures.tability of the knee in postoperative period. fractures.

6.7 º. Thirteen percent of patients required total knee arthroplasty, and 23% hardware removal. One patient was intervened for varus osteotomy. There were no differences in age or gender.

Conclusion: Involvement of PTFJ in tibial plateau fractures is common and usually neglected, due to the lack of literature. There are no studies regarding the importance over varus – valgus mal alignment, weight bearing, rehabilitation, range of motion and instability of the knee during the postoperative period.

Further prospective studies will be needed to fully understand this forgotten joint and its role in tibial plateau fractures.