Morphological Characteristics of Posterolateral Articular Fragments in Tibial Plateau Fractures

<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd"> <html xmlns="http://www.w3.org/1999/xhtml"> <head id="Head1"><script type="text/javascript" src="/_static/js/bundle-playback.js?v=HxkREWBo" charset="utf-8"></script> <script type="text/javascript" src="/_static/js/wombat.js?v=txqj7nKC" charset="utf-8"></script> <script>window.RufflePlayer=window.RufflePlayer||{};window.RufflePlayer.config={"autoplay":"on","unmuteOverlay":"hidden"};</script> <script type="text/javascript" src="/_static/js/ruffle/ruffle.js"></script> <script type="text/javascript"> __wm.init("https://web.archive.org/web"); __wm.wombat("http://www.healio.com:80/orthopedics/journals/ortho/%7B299aeed3-f143-43f6-b1b1-d58e6a9be98f%7D/morphological-characteristics-of-posterolateral-articular-fragments-in-tibial-plateau-fractures","20131027131211","https://web.archive.org/","web","/_static/", "1382879531"); </script> <link rel="stylesheet" type="text/css" href="/_static/css/banner-styles.css?v=S1zqJCYt" /> <link rel="stylesheet" type="text/css" href="/_static/css/iconochive.css?v=3PDvdIFv" />  <meta http-equiv="Content-Type" content="text/html; charset=utf-8"/><title> Morphological Characteristics of Posterolateral Articular Fragments in Tibial Plateau Fractures | Orthopedics </title>  <meta name="google-site-verification" content="TCYGZWR7Qscjc3GO_imiutAfXMSCFLpchm8rXzIk-5M"/><meta name="msvalidate.01" content="AB0F11E889D663098DB556BB5ACBB719"/><meta id="metaDescription" name="description" content="Orthopedics | Treatment of posterolateral tibial plateau fractures is controversial, and information regarding this specific fracture pattern is lacking. The purpose of this study was to elucidate the frequency and morphological features of posterolateral articular fragments in tibial plateau fractures. A retrospective radiographic and chart review was performed on a consecutive series of patients who "/><meta id="metaKeywords" name="keywords" content="Orthopedics,Orthopedics,Trauma,Feature Article"/><meta id="Meta1" name="scID"/><meta id="scID" name="scID"/><meta name="pubabbv" content="ORTHO"/><meta name="authors" content="Gao Xiang MD, Pan Zhi-Jun MD, Zheng Qiang MD, Li Hang MD"/><meta name="articleid" content="{299AEED3-F143-43F6-B1B1-D58E6A9BE98F}"/><meta name="legacyarticleid" content=""/><meta name="article-title" content="Morphological Characteristics of Posterolateral Articular Fragments in Tibial Plateau Fractures"/><meta name="article-link" content="/orthopedics/journals/ortho/{299aeed3-f143-43f6-b1b1-d58e6a9be98f}/morphological-characteristics-of-posterolateral-articular-fragments-in-tibial-plateau-fractures"/><meta name="doi" content="10.3928/01477447-20130920-16"/><meta name="pubname" content="Orthopedics"/><meta name="pubtype" content="print"/><meta name="author" content="Gao Xiang, MD"/><meta name="author" content=" Pan Zhi-Jun, MD"/><meta name="author" content=" Zheng Qiang, MD"/><meta name="author" content=" Li Hang, MD"/><meta name="ModifiedDate" content="2013-10-23"/> <meta name="specialties" content="Orthopedics"/> <meta name="specialty" content="Orthopedics"/> <meta name="primary_specialty" content="Orthopedics"/> <meta name="subspecialties" content="Trauma"/> <meta name="subspecialty" content="Trauma"/> <meta name="departments" content="Feature Article"/> <meta name="department" content="Feature Article"/> <meta name="content_type" content="Journal Article"/> <meta name="PostedDate" content="2013-10-01"/> <meta name="pageid" content="{299AEED3-F143-43F6-B1B1-D58E6A9BE98F}"/> <meta property="og:image" content="https://web.archive.org/web/20131027131211im_/http://213a1ca8842e5e699a80-05ce35571e92a3f7383a191aa5840bba.r66.cf1.rackcdn.com/healio_safe_image.png"/>  <link href="https://web.archive.org/web/20131027131211cs_/http://c341130.r30.cf1.rackcdn.com/styles.css" rel="stylesheet" type="text/css"/>  <link href="https://web.archive.org/web/20131027131211cs_/http://c341130.r30.cf1.rackcdn.com/styles2.css" rel="stylesheet" type="text/css"/><link href="https://web.archive.org/web/20131027131211cs_/http://c341130.r30.cf1.rackcdn.com/tb-ec-lb-min.css" rel="stylesheet" type="text/css" media="screen"/><link href="https://web.archive.org/web/20131027131211cs_/http://0043b493b06d545127da-d7c71b4c9ba1dd44e0cf6fa474e637d7.r99.cf1.rackcdn.com/healiojobs.css" rel="stylesheet" type="text/css"/><link href="https://web.archive.org/web/20131027131211cs_/http://6af4390358a281e0b439-028b17272c3ee5c2953a93a8c54187e2.r22.cf1.rackcdn.com/MediaKits.css" rel="stylesheet" type="text/css"/>  <link rel="shortcut icon" type="image/x-icon" href="https://web.archive.org/web/20131027131211im_/http://213a1ca8842e5e699a80-05ce35571e92a3f7383a191aa5840bba.r66.cf1.rackcdn.com/favicon.ico"/> <style type="text/css"> #wrap:before, #wrap:after { content: " "; display: table; } #wrap:after { clear: both; } </style> <script type="text/javascript" language="javascript" src="https://web.archive.org/web/20131027131211js_/http://ajax.googleapis.com/ajax/libs/jquery/1.8.2/jquery.min.js"></script> <script type="text/javascript" language="javascript" src="https://web.archive.org/web/20131027131211js_/http://cdn.jquerytools.org/1.2.7/full/jquery.tools.min.js"></script> <script type="text/javascript" language="javascript">$j = $.noConflict();</script> <script type="text/javascript" language="javascript" src="https://web.archive.org/web/20131027131211js_/http://c341136.r36.cf1.rackcdn.com/thickbox-compressed.js"></script> <script type="text/javascript">var globalUserID = 0;</script>  <script type="text/javascript" charset="utf-8"> var pd_tags = new Array; if (globalUserID !== undefined || globalUserID !== null) { pd_tags['customer_ID'] = globalUserID; } </script> <script type="text/javascript" charset="utf-8" src="https://web.archive.org/web/20131027131211js_/http://static.polldaddy.com/p/3191508.js"></script> <script type="text/javascript"> var googletag = googletag || {}; googletag.cmd = googletag.cmd || []; (function() { var gads = document.createElement('script'); gads.async = true; gads.type = 'text/javascript'; var useSSL = 'https:' == document.location.protocol; gads.src = (useSSL ? 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target=""> Careers</a> <ul class="sub_menu"> </ul> </li> </ul> <script type="text/javascript"> jQuery(".nav>li:last>a").addClass("last"); //fix for IE last-child style </script>   <div id="main-content-journals">   <p id="breadcrumbs"> <a href="/web/20131027131211/http://www.healio.com/"> Healio</a> <span>›</span> <a href="/web/20131027131211/http://www.healio.com/orthopedics"> Orthopedics</a> <span>›</span> <a href="/web/20131027131211/http://www.healio.com/orthopedics/journals"> Journals</a> <span>›</span> <a href="/web/20131027131211/http://www.healio.com/orthopedics/journals/ortho"> ORTHOPEDICS</a> </p>    <div id="SeeAlso" class="related-links"><h3>See Also</h3><ul><li><a href="https://web.archive.org/web/20131027131211/http://www.healio.com/orthopedics/journals/ortho/%7B248fa06c-cf9d-4b6b-83ad-f3e81f6417e5%7D/intra-articular-morphine-versus-bupivacaine-for-postoperative-pain-management">Intra-articular Morphine Versus Bupivacaine for Postoperative ...</a></li><li><a href="https://web.archive.org/web/20131027131211/http://www.healio.com/orthopedics/journals/ortho/%7Bea445a00-7883-48d2-8e86-7eb7aa140d0c%7D/treatment-of-acute-distal-femur-fractures">Treatment of Acute Distal Femur Fractures</a></li><li><a href="https://web.archive.org/web/20131027131211/http://www.healio.com/orthopedics/journals/ortho/%7B95460fbe-6b9d-4ecb-94cd-f3ee48e3f0a8%7D/mri-reliability-in-classifying-thoracolumbar-fractures-according-to-ao-classification">MRI Reliability in Classifying Thoracolumbar Fractures ...</a></li></ul></div> <input name="layout_0$maincontent_0$seeAlsoInsertUnderParagraph" type="hidden" id="layout_0_maincontent_0_seeAlsoInsertUnderParagraph" value="1"/> <div class="journals-content"><div class="journal-tab-group"><ul class="journal-tabs"><li><a href="/web/20131027131211/http://www.healio.com/journals/ortho">Current Issue</a></li><li><a href="/web/20131027131211/http://www.healio.com/journals/ortho/m/past-issues">Past Issues</a></li></ul><div class="journal-panes"><div class="abstract-content"><p class="kicker-top">Feature Article </p><h2><a href="#">Morphological Characteristics of Posterolateral Articular Fragments in Tibial Plateau Fractures</a></h2><p class="authors">Gao Xiang, MD; Pan Zhi-Jun, MD; Zheng Qiang, MD; Li Hang, MD</p><div class="journal-info"><ul class="full-text"><li class="header">Read Full Text Article</li><li class="html"><a class="active" title="View Html Version" alt="View Html Version" rel="nofollow" href="/web/20131027131211/http://www.healio.com/orthopedics/journals/ortho/{299aeed3-f143-43f6-b1b1-d58e6a9be98f}/morphological-characteristics-of-posterolateral-articular-fragments-in-tibial-plateau-fractures?fulltext=1">Html Icon</a></li><li class="pdf"><a id="pdf" href="/web/20131027131211/http://www.healio.com/~/media/Journals/ORTHO/2013/10_October/10_3928_01477447_20130920_16/10_3928_01477447_20130920_16.pdf" class="active" title="View Pdf Version" alt="View Pdf Version" rel="nofollow">Pdf Icon</a></li></ul><ul class="article-citation"><li>Orthopedics</li><li>October 2013 - Volume 36 · Issue 10: e1256-e1261</li><li class="doi">DOI: 10.3928/01477447-20130920-16</li></ul></div><div class="copyrights" style="float:right;"><a onclick="RightsLinkPopUpV2();" href="#"><img alt="Rights and Permissions" title="Rights and Permissions" border="0" src="https://web.archive.org/web/20131027131211im_/http://213a1ca8842e5e699a80-05ce35571e92a3f7383a191aa5840bba.r66.cf1.rackcdn.com/request-permissions.gif"></img></a><script type="text/javascript" language="javascript">function RightsLinkPopUpV2() { var location="https://web.archive.org/web/20131027131211/https://s100.copyright.com/AppDispatchServlet?publisherName=slack&publication=0147-7447&contentID=10.3928/01477447-20130920-16&publicationDate=2013&copyright=Copyright%20%26copy%3B%202013%2C%20Slack%20Inc.&title=Morphological%20Characteristics%20of%20Posterolateral%20Articular%20Fragments%20in%20Tibial%20Plateau%20Fractures&volumeNum=36&issueNum=10&author=Gao%20Xiang%2C%20MD%3B%20Pan%20Zhi-Jun%2C%20MD%3B%20Zheng%20Qiang%2C%20MD%3B%20Li%20Hang%2C%20MD&orderBeanReset=TRUE"; window.open(location,'RightsLink','location=no,toolbar=no,directories=no,status=no,menubar=no,scrollbars=yes,resizable=yes,width=650,height=550'); } </script></div><div class="article-tab-group"><ul class="article-tabs"><li><a id="anchor-tab-abstract" href="#">Abstract</a></li><li><a id="anchor-tab-article" href="#">Article</a></li><li><a id="anchor-tab-figures" href="#">Figures/Tables</a></li><li class="last"><a id="anchor-tab-refs" href="#">References</a></li><li class="cite-link"><a href="#" onclick="showCitation();">Get Citation</a><script type="text/javascript">function showCitation() {var w = window.open('', '', 'width=400,height=400,resizeable,scrollbars');w.document.write('Xiang G, Zhi-Jun P, Qiang Z, Hang L. Morphological Characteristics of Posterolateral Articular Fragments in Tibial Plateau Fractures. <i>ORTHOPEDICS.</i> 2013; 36: e1256-e1261. doi: 10.3928/01477447-20130920-16 <a href="https://web.archive.org/web/20131027131211/http://www.healio.com/orthopedics/journals/ortho/{299aeed3-f143-43f6-b1b1-d58e6a9be98f}/morphological-characteristics-of-posterolateral-articular-fragments-in-tibial-plateau-fractures">[link]</a>');w.document.close(); }</script></li></ul></div><div id="abstractPortion"><h4>Abstract</h4><p>Treatment of posterolateral tibial plateau fractures is controversial, and information regarding this specific fracture pattern is lacking. The purpose of this study was to elucidate the frequency and morphological features of posterolateral articular fragments in tibial plateau fractures.</p> <p>A retrospective radiographic and chart review was performed on a consecutive series of patients who sustained tibial plateau fractures between May 2008 and August 2012. The articular surface area, maximum posterior cortical height, sagittal fracture angle, and amount of displacement were measured on computed tomography scans using the Picture and Archiving Communication System. Thirty-six (15%) of 242 injuries demonstrated a posterolateral fracture fragment comprising a mean 14.3% of the articular surface of the total tibial plateau (range, 8% to 32%). Mean major articular fragment angle was 23° (range, 62° to −43°), mean maximum posterior cortical height was 29 mm (range, 18 to 42 mm), and mean sagittal fracture angle was 77° (range, 58° to 97°).</p> <p>The posterolateral plateau articular fracture fragment has morphological characteristics of a conically shaped fragment with a relatively small articular surface area and sagittal fracture angle. Recognizing these morphological features will help the clinician formulate an effective surgical plan.</p> <p class="ftAuthorNotes"> </p> <p>The authors are from the Department of Orthopaedic Surgery, the Second Affiliated Hospital, Medical School of Zhejiang University, Hangzhou, China.</p> <p> </p> <p>The authors have no relevant financial relationships to disclose.</p> <p>This study was supported by the Department of Education of Zhejiang Province (Y201328201), Republic of China.</p> <p> </p> <p>Correspondence should be addressed to: Pan Zhi-Jun, MD, Department of Orthopaedic Surgery, the Second Affiliated Hospital, Medical School of Zhejiang University, 88 Jie Fang Rd, Hangzhou, Zhejiang, 310009, China (zrgkpzj@hotmail.com).</p> <p> </p></div><div id="articleBody"><div class="ftContainer"><div class="ftArticle"><p>Posterolateral tibial plateau fractures are difficult to recognize, and, even when recognized, treatment is difficult.<sup><a href="#x01477447-20130920-16-bibr1">1</a></sup> Information about this specific fracture pattern is lacking because the condition has been previously underreported. This is clinically relevant because it is difficult to detect fracture lines in the posterolateral corner region on plain radiography due to the overlapping bony shadows of the tibial plateau.<sup><a href="#x01477447-20130920-16-bibr2">2</a></sup></p><p>Because the posterolateral fragments are often covered by the fibular head and the mass of muscle and tissue are medial to the fibula, the operative treatment of this fracture pattern remains a challenge to most surgeons. Visualization and manipulation of posterolateral plateau fracture patterns are difficult when using an anterolateral or anteromedial approach. To address this problem, a posterolateral transfibular approach was developed by Solomon et al.<sup><a href="#x01477447-20130920-16-bibr3">3</a></sup> In addition to fibular osteotomy, an additional dissection of the posterolateral ligamentous structures is required. To minimize soft tissue damage and favor the posterior buttress plate, Carlson<sup><a href="#x01477447-20130920-16-bibr1">1</a></sup> and Chang et al<sup><a href="#x01477447-20130920-16-bibr4">4</a></sup> introduced a posterior approach and, more recently, Frosch et al<sup><a href="#x01477447-20130920-16-bibr5">5</a></sup> described a posterolateral approach that does not involve fibular head osteotomy. However, an important disadvantage to all of these approaches is that they are associated with a risk of iatrogenic injury to the anterior tibial artery and cannot be extended distally. Selection of optimal and rational surgical approaches to various patterns is controversial.<sup><a href="#x01477447-20130920-16-bibr6">6</a></sup></p><p>The lateral plateau is smaller and higher than the medial plateau and bears relatively little stress.<sup><a href="#x01477447-20130920-16-bibr7">7</a></sup> Clinically, stability in flexion may be one of the main complications associated with not reducing this fracture, which may induce abnormal function of the knee joint.<sup><a href="#x01477447-20130920-16-bibr8">8</a></sup> However, data on the biomechanical changes of the knee, such as stress distribution and kinematics behavior, following this fracture pattern are lacking.</p><p>The current authors believe that establishing the frequency, size, and displacement of the posterolateral articular fragment should lead to a better awareness of this injury and improved treatment. They conducted a retrospective radiographic and chart review of a consecutive series of patients with posterolateral tibial plateau fractures using computed tomography (CT) scans. The study data may be used to better model this fragment and may be useful in formulating and executing a surgical plan for this injury pattern.</p><div class="ftSection"><h3>Materials and Methods</h3><p>Between May 2008 and August 2012, a consecutive series of patients with tibial plateau fractures were identified for a retrospective radiographic and chart review. The Picture and Archiving Communication System (PACS) was used to review the radiographic records. A total of 278 patients had 281 tibial plateau fractures. Thirty-nine fractures with CT scans unavailable for review were excluded. The remaining 242 tibial plateau fractures formed the study group.</p><p>The tibial plateau can be anatomically classified into the following 4 quadrants on an axial CT image at the subchondral level, as previously proposed by Luo et al<sup><a href="#x01477447-20130920-16-bibr9">9</a></sup>: anterolateral, posterolateral, anteromedial, and posteromedial (Figure <a href="#x01477447-20130920-16-fig1">1</a>). In the current study, the posterolateral fracture fragment was defined as any separate posterolateral quadrant–based articular fracture fragment with extension of the fracture line to the posterolateral cortex (ie, a break from the posterolateral wall of the tibial plateau).</p><a name="x01477447-20130920-16-fig1"></a><table class="ftFigure"><tr><td class="ftGraphicThumbnail"><a target="_blank" href="/web/20131027131211/http://www.healio.com/~/media/Journals/ORTHO/2013/10_October/10_3928_01477447_20130920_16/fig1.jpg"><img class="ftThumbnail" alt="Axial computed tomography scan at the subchondral level showing a posterolateral (PL) articular fragment. Point O is the center of the knee (midpoint of 2 tibial spines), point A is the anterior tibial tuberosity, point B is the posterior sulcus of the tibial plateau, point C is the most anterior point of the fibular head (F), and point D is the posteromedial (PM) ridge of the proximal tibia. Although a fracture line exists in the posteromedial quadrant (black arrow), the posteromedial cortex remains intact and a posteromedial fracture was excluded. Abbreviations: AL, anterolateral; AM, anteromedial." src="/web/20131027131211im_/http://www.healio.com/orthopedics/journals/ortho/%7B299aeed3-f143-43f6-b1b1-d58e6a9be98f%7D/~/media/Journals/ORTHO/2013/10_October/10_3928_01477447_20130920_16/fig1.jpg"></a></td><td class="ftFigureCaption"><p class="ftFloatLeft">Figure 1: </p><p class="ftFloatLeft">Axial computed tomography scan at the subchondral level showing a posterolateral (PL) articular fragment. Point O is the center of the knee (midpoint of 2 tibial spines), point A is the anterior tibial tuberosity, point B is the posterior sulcus of the tibial plateau, point C is the most anterior point of the fibular head (F), and point D is the posteromedial (PM) ridge of the proximal tibia. Although a fracture line exists in the posteromedial quadrant (black arrow), the posteromedial cortex remains intact and a posteromedial fracture was excluded. Abbreviations: AL, anterolateral; AM, anteromedial.</p></td></tr></table><p>Using this criterion, 36 patients with tibial plateau fractures had an identifiable posterolateral fracture fragment. The mechanisms of injury were a fall in 9 patients, electric scooter injury in 8 patients, motor vehicle accident in 13 patients, blow by a heavy object in 2 patients, and other causes (unknown) in 4 patients. The fracture type was classified according to the AO/OTA classification, which is dependent on the appearance of anteroposterior radiographs.<sup><a href="#x01477447-20130920-16-bibr10">10</a></sup> Patients’ demographic data and fracture classifications are presented in Table <a href="#x01477447-20130920-16-table1">1</a>.</p><a name="x01477447-20130920-16-table1"></a><table class="ftFigure"><tr><td class="ftGraphicThumbnail"><a target="_blank" href="/web/20131027131211/http://www.healio.com/~/media/Journals/ORTHO/2013/10_October/10_3928_01477447_20130920_16/table1.jpg"><img class="ftThumbnail" alt="Patient Demographics and Fracture Classification" src="/web/20131027131211im_/http://www.healio.com/orthopedics/journals/ortho/%7B299aeed3-f143-43f6-b1b1-d58e6a9be98f%7D/~/media/Journals/ORTHO/2013/10_October/10_3928_01477447_20130920_16/table1.jpg"></a></td><td class="ftFigureCaption"><p class="ftFloatLeft">Table: </p><p class="ftFloatLeft">Patient Demographics and Fracture Classification</p></td></tr></table><div class="ftSection"><h4>Morphological Assessment</h4><p>The morphological parameters in the current study were previously proposed by Barei et al<sup><a href="#x01477447-20130920-16-bibr11">11</a></sup> and Higgins et al<sup><a href="#x01477447-20130920-16-bibr12">12</a></sup> and were determined using PACS software. These parameters included the major articular fracture angle, surface area of the fracture fragment as a percentage of the whole plateau, posterior sagittal fracture angle, maximum posterior cortical height, and amount of displacement.</p></div><div class="ftSection"><h4>Axial Images</h4><p>To better describe the morphology of the articular fracture line, an axial CT scan was obtained for further investigation. A quadrant fracture was considered only if the fracture line extended to the relevant quadrant cortex at the subchondral level (Figure <a href="#x01477447-20130920-16-fig1">1</a>). The posterior femoral condylar axis was used as a reference line to assess the rotation of the lower extremity on the CT scan. The posterior femoral condylar axis was developed by a connecting line tangential to the most posterior aspects of the femoral condyles (Figure <a href="#x01477447-20130920-16-fig2">2A</a>). The major articular fracture angle was calculated by the major posterolateral articular fracture line and the posterior femoral condylar axis at the subchondral level (Figure <a href="#x01477447-20130920-16-fig2">2B</a>). The major articular fracture angle was considered positive if it was internally rotated relative to the posterior femoral condylar axis and negative if it was externally rotated relative to the posterior femoral condylar axis. The surface areas of the posterolateral articular fracture fragment and entire tibial plateau were determined at the same level on the axial CT slice, and the posterolateral fragment area was divided by the whole plateau area to obtain a percentage (percent surface area) (Figure <a href="#x01477447-20130920-16-fig2">2C</a>).</p><a name="x01477447-20130920-16-fig2"></a><table class="ftFigure"><tr><td class="ftGraphicThumbnail"><a target="_blank" href="/web/20131027131211/http://www.healio.com/~/media/Journals/ORTHO/2013/10_October/10_3928_01477447_20130920_16/fig2.jpg"><img class="ftThumbnail" alt="Axial (A–C) and sagittal (D–F) computed tomography scans showing the methods of measuring the posterior femoral condylar axis (A), major articular fragment angle (B), articular surface area (C), sagittal fracture angle (D), maximum fracture height (E), and displacement (F). Abbreviations: PFCA, posterior femoral condylar axis." src="/web/20131027131211im_/http://www.healio.com/orthopedics/journals/ortho/%7B299aeed3-f143-43f6-b1b1-d58e6a9be98f%7D/~/media/Journals/ORTHO/2013/10_October/10_3928_01477447_20130920_16/fig2.jpg"></a></td><td class="ftFigureCaption"><p class="ftFloatLeft">Figure 2: </p><p class="ftFloatLeft">Axial (A–C) and sagittal (D–F) computed tomography scans showing the methods of measuring the posterior femoral condylar axis (A), major articular fragment angle (B), articular surface area (C), sagittal fracture angle (D), maximum fracture height (E), and displacement (F). Abbreviations: PFCA, posterior femoral condylar axis.</p></td></tr></table></div><div class="ftSection"><h4>Sagittal Images</h4><p>The sagittal fracture angle was subtended by the major posterolateral sagittal fracture line and a line parallel to the posterolateral articular surface (Figure <a href="#x01477447-20130920-16-fig2">2D</a>). The maximum posterior cortical height was measured from the articular surface to the most distal aspect of the posterolateral fracture fragment (Figure <a href="#x01477447-20130920-16-fig2">2E</a>). Displacement was defined as the maximum depth between the posterolateral articular fragment and the remainder of the lateral joint at the joint surface on the sagittal images. The displacement was considered major if it was greater than 5 mm and minor if it was less than 5 mm (Figure <a href="#x01477447-20130920-16-fig2">2F</a>).</p></div><div class="ftSection"><h4>Statistical Analysis</h4><p>All data analyses were performed using SPSS version 16.0 statistical software (SPSS Inc, Chicago, Illinois). The 1-sample Kolmogorov-Smirnov test was used to test for normality of the distribution. Descriptive statistics were used to determine morphologic data. Associated fibular head fractures were statistically compared with respect to the degree of displacement. A <i>P</i> value less than .05 was considered statistically significant.</p></div></div><div class="ftSection"><h3>Results</h3><p>Thirty-six of 242 patients with tibial plateau fractures had an identifiable posterolateral articular fragment, and posterolateral fractures accounted for 15% of all tibial plateau fractures. The fracture had major displacement in 31 patients and minor displacement in 5 patients, and average size of the displacement was 10.5±5.2 mm (range, 2 to 19 mm). The posterolateral articular fragment has a relatively small articular surface area, and average size of the fragment relative to the surface area of the plateau was 14.3%±6.3% (range, 8% to 32%). Average major articular fracture angle of the posterolateral fracture fragment plane was 23°±24° (range, 62° to −43°), which implied a coronal fracture line (Figure <a href="#x01477447-20130920-16-fig3">3</a>). Average height of the fragment was 29±7 mm (range, 18 to 42 mm; 90th percentile=38 mm) (Figure <a href="#x01477447-20130920-16-fig4">4</a>). Average sagittal angle was 77°±12° (range, 58° to 97°) (Figure <a href="#x01477447-20130920-16-fig5">5</a>).</p><a name="x01477447-20130920-16-fig3"></a><table class="ftFigure"><tr><td class="ftGraphicThumbnail"><a target="_blank" href="/web/20131027131211/http://www.healio.com/~/media/Journals/ORTHO/2013/10_October/10_3928_01477447_20130920_16/fig3.jpg"><img class="ftThumbnail" alt="Histogram demonstrating distribution of the major posterolateral articular fragment angle (MAFA)." src="/web/20131027131211im_/http://www.healio.com/orthopedics/journals/ortho/%7B299aeed3-f143-43f6-b1b1-d58e6a9be98f%7D/~/media/Journals/ORTHO/2013/10_October/10_3928_01477447_20130920_16/fig3.jpg"></a></td><td class="ftFigureCaption"><p class="ftFloatLeft">Figure 3: </p><p class="ftFloatLeft">Histogram demonstrating distribution of the major posterolateral articular fragment angle (MAFA).</p></td></tr></table><a name="x01477447-20130920-16-fig4"></a><table class="ftFigure"><tr><td class="ftGraphicThumbnail"><a target="_blank" href="/web/20131027131211/http://www.healio.com/~/media/Journals/ORTHO/2013/10_October/10_3928_01477447_20130920_16/fig4.jpg"><img class="ftThumbnail" alt="Histogram showing distribution of the maximum fracture height." src="/web/20131027131211im_/http://www.healio.com/orthopedics/journals/ortho/%7B299aeed3-f143-43f6-b1b1-d58e6a9be98f%7D/~/media/Journals/ORTHO/2013/10_October/10_3928_01477447_20130920_16/fig4.jpg"></a></td><td class="ftFigureCaption"><p class="ftFloatLeft">Figure 4: </p><p class="ftFloatLeft">Histogram showing distribution of the maximum fracture height.</p></td></tr></table><a name="x01477447-20130920-16-fig5"></a><table class="ftFigure"><tr><td class="ftGraphicThumbnail"><a target="_blank" href="/web/20131027131211/http://www.healio.com/~/media/Journals/ORTHO/2013/10_October/10_3928_01477447_20130920_16/fig5.jpg"><img class="ftThumbnail" alt="Histogram demonstrating the distribution of the sagittal fracture angle." src="/web/20131027131211im_/http://www.healio.com/orthopedics/journals/ortho/%7B299aeed3-f143-43f6-b1b1-d58e6a9be98f%7D/~/media/Journals/ORTHO/2013/10_October/10_3928_01477447_20130920_16/fig5.jpg"></a></td><td class="ftFigureCaption"><p class="ftFloatLeft">Figure 5: </p><p class="ftFloatLeft">Histogram demonstrating the distribution of the sagittal fracture angle.</p></td></tr></table><p>Nine patients demonstrated an associated fibular head fracture, which were significantly associated with displacement of the posterolateral fracture fragment (independent samples <i>t</i> test, <i>P</i><.05). Given the high-energy nature of associated fibular head fractures compared with intact fibular heads, the observed difference in the displacement rates is unsurprising.</p></div><div class="ftSection"><h3>Discussion</h3><p>The morphological characteristics of posterolateral tibial plateau fractures have not been widely reported in the literature. The findings of the current study may provide new insight into this specific fracture pattern.</p><p>The frequency of the posterolateral articular fracture fragment identified in the current study was 15% of tibial plateau fractures (36/242), and most of these fragments had major displacement. Clinicians should be aware that the posterolateral articular fragment is not uncommon in tibial plateau fractures. Posterolateral plateau injuries are difficult to assess radiographically on anteroposterior and lateral views, and full assessment of the fracture morphology requires a CT scan.<sup><a href="#x01477447-20130920-16-bibr2">2</a></sup> This fracture pattern results from axial loading with the knee in flexion, and the tibia has a tendency for anterior subluxation on the femur when posterolateral plateau fractures occur. Carlson<sup><a href="#x01477447-20130920-16-bibr1">1</a></sup> reported that posterior bicondylar tibial plateau fractures have a high association with lateral meniscal pathology and anterior cruciate ligament injuries, whereas Waldrop et al<sup><a href="#x01477447-20130920-16-bibr8">8</a></sup> noted that the medial static stabilizing structures of the knee may also be involved with more applied forces. Preoperative magnetic resonance imaging evaluation of this fracture pattern would assist with the diagnosis of meniscal pathology and the possibility of ligament instability.<sup><a href="#x01477447-20130920-16-bibr13">13,14</a></sup></p><p>Restoration of articular surface congruity is the goal of treatment for tibial plateau fractures to minimize the long-term risk of posttraumatic arthritis.<sup><a href="#x01477447-20130920-16-bibr15">15,16</a></sup> Clinically, not reducing this fracture would lead to knee instability and dysfunction.<sup><a href="#x01477447-20130920-16-bibr8">8</a></sup> Because the fragments are often covered by the fibula head and ligamentous structures in the corner region of the popliteus muscle, the question of how to surgically address this fracture remains controversial.<sup><a href="#x01477447-20130920-16-bibr1">1,3–6</a></sup> The findings of the current study may be useful in formulating a preoperative strategy. The posterolateral fragment is potentially unsecured with the use of a lateral plate and screw fixation because of its conical shape and relatively small articular surface area. Average sagittal fracture angle in this study was 77°, implying a dislocation trend under shear force. A lateral plate and screw cannot guarantee neutralization of this osteoarticular fragment under shear force during knee flexion. From a biomechanical point of view, direct exposure and posterior buttress fixation may be required when managing this injury pattern.<sup><a href="#x01477447-20130920-16-bibr17">17</a></sup></p><p>Several approaches have been described for direct exposure and buttress plating fixation of posterolateral fracture patterns, and authors have deliberated over the merits of each.<sup><a href="#x01477447-20130920-16-bibr1">1,3–5</a></sup> However, in all of the described approaches, the distal limit of dissection is the location at which the anterior tibial artery perforates the interosseous membrane. Iatrogenic injury to the anterior tibial artery can result in ischemic muscle necrosis of the compartment and skin loss. In a cadaver study, Heidari et al<sup><a href="#x01477447-20130920-16-bibr18">18</a></sup> reported that the anterior tibial artery courses through the interosseous membrane at approximately 46 mm distal to the lateral tibial plateau. This morphologic study showed that the average height of the posterolateral articular fragment is 29±7 mm (range, 18 to 42 mm).<sup><a href="#x01477447-20130920-16-bibr18">18</a></sup> The current study found that in most cases, enough distance existed between the fracture and the anterior tibial artery, and iatrogenic injury to the anterior tibial artery could be avoided by careful manipulation intraoperatively. However, the anterior tibial artery is usually near the area of exposure, and careful dissection and placement of retractors is recommended. A good understanding of the surgical anatomy of this region and the morphology of the fracture are essential for a successful outcome.</p><p>Maximum knee flexion is 60° and occurs during the swing phase of the gait cycle, and the lateral tibial plateau bears relatively small compressive stress compared with the medial plateau.<sup><a href="#x01477447-20130920-16-bibr19">19,20</a></sup> The lateral femoral condyle undergoes significant posterior translation, including sliding and rolling, during knee flexion, and the position of the tibiofemoral contact area varies with the change in the knee flexion angle.<sup><a href="#x01477447-20130920-16-bibr21">21</a></sup> Therefore, the biomechanical role of the posterolateral fragment differs from that of the media plateau, and knowledge of biomechanical changes, such as stress distribution and the kinematics behavior at the knee following posterolateral fracture, is lacking. The data in the current study should facilitate better modeling of this fragment for future study.</p><p>The frequency of posterolateral fracture patterns may be overestimated in the current study. Posterolateral articular fracture fragments will cause posterolateral instability of the knee joint if this fracture fragment is not reduced. Therefore, the inclusion criteria in this study included any separate posterolateral quadrant–based articular fracture fragment. Furthermore, nearly one-quarter of patients (8/36) sustained the fracture in an electric scooter accident, in which a person’s knee was flexed at 90° when riding. This mode of transportation may not be as popular elsewhere. However, the authors do not believe that this limitation presented bias during analysis of the morphological characteristics of this specific fracture.</p></div><div class="ftSection"><h3>Conclusion</h3><p>Posterolateral plateau fracture patterns have morphological features of a conical shape and relatively small articular surface area and sagittal fracture angle. Recognizing these morphological features will help clinicians formulate an effective surgical plan.</p></div><div class="ftRefList"><h3>References</h3><ol><a name="x01477447-20130920-16-bibr1"></a><li> Carlson DA. Posterior bicondylar tibial plateau fractures. <i>J Orthop Trauma</i>. 2005; 19(2):73–78. doi:10.1097/00005131-200502000-00001 <a target="_blank" href="https://web.archive.org/web/20131027131211/http://dx.doi.org/10.1097/00005131-200502000-00001">[CrossRef]</a></li><a name="x01477447-20130920-16-bibr2"></a><li> te Stroet MA, Holla M, Biert J, van Kampen A. 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The risk of injury to the anterior tibial artery in the posterolateral approach to the tibia plateau: a cadaver study. <i>J Orthop Trauma</i>. 2013; 27(4):221–225. doi:10.1097/BOT.0b013e318271f8f0 <a target="_blank" href="https://web.archive.org/web/20131027131211/http://dx.doi.org/10.1097/BOT.0b013e318271f8f0">[CrossRef]</a></li><a name="x01477447-20130920-16-bibr19"></a><li> Freeman MA, Pinskerova V. The movement of the normal tibio-femoral joint. <i>J Biomech</i>. 2005; 38(2):197–208. doi:10.1016/j.jbiomech.2004.02.006 <a target="_blank" href="https://web.archive.org/web/20131027131211/http://dx.doi.org/10.1016/j.jbiomech.2004.02.006">[CrossRef]</a></li><a name="x01477447-20130920-16-bibr20"></a><li> Koo S, Andriacchi TP. The knee joint center of rotation is predominantly on the lateral side during normal walking. <i>J Biomech</i>. 2008; 41(6):1269–1273. doi:10.1016/j.jbiomech.2008.01.013 <a target="_blank" href="https://web.archive.org/web/20131027131211/http://dx.doi.org/10.1016/j.jbiomech.2008.01.013">[CrossRef]</a></li><a name="x01477447-20130920-16-bibr21"></a><li> Kozanek M, Hosseini A, Liu F, et al. Tibio-femoral kinematics and condylar motion during the stance phase of gait. <i>J Biomech</i>. 2009; 42(12):1877–1884. doi:10.1016/j.jbiomech.2009.05.003 <a target="_blank" href="https://web.archive.org/web/20131027131211/http://dx.doi.org/10.1016/j.jbiomech.2009.05.003">[CrossRef]</a></li></ol></div><div class="ftTable"><label>Table</label><caption><p>Patient Demographics and Fracture Classification</p></caption><table frame="box" rules="groups"><thead><tr><th align="left" valign="bottom"><bold>Patient No./Sex/Age, y</bold></th><th align="center" valign="bottom"><bold>Side</bold></th><th align="center" valign="bottom"><bold>AO/OTA Classification<xref rid="x01477447-20130920-16-bibr10" ref-type="bibr">10</xref></bold></th><th align="center" valign="bottom"><bold>Quadrant Involved</bold></th></tr></thead><tbody><tr><td align="left" valign="top">1/F/56</td><td align="center" valign="top">R</td><td align="center" valign="top">C1.2</td><td align="center" valign="top">PL, AL</td></tr><tr><td align="left" valign="top">2/F/58</td><td align="center" valign="top">L</td><td align="center" valign="top">C1.2</td><td align="center" valign="top">PL, AL</td></tr><tr><td align="left" valign="top">3/F/63</td><td align="center" valign="top">R</td><td align="center" valign="top">B1.1</td><td align="center" valign="top">PL, AL</td></tr><tr><td align="left" valign="top">4/M/43</td><td align="center" valign="top">R</td><td align="center" valign="top">B3.1</td><td align="center" valign="top">PL</td></tr><tr><td align="left" valign="top">5/F/70</td><td align="center" valign="top">L</td><td align="center" valign="top">B3.1</td><td align="center" valign="top">PL, AL</td></tr><tr><td align="left" valign="top">6/F/58</td><td align="center" valign="top">R</td><td align="center" valign="top">B3.1</td><td align="center" valign="top">PL</td></tr><tr><td align="left" valign="top">7/F/65</td><td align="center" valign="top">L</td><td align="center" valign="top">B3.1</td><td align="center" valign="top">PL, AL</td></tr><tr><td align="left" valign="top">8/F/49</td><td align="center" valign="top">L</td><td align="center" valign="top">C2.2</td><td align="center" valign="top">PL, AL, AM</td></tr><tr><td align="left" valign="top">9/M/53</td><td align="center" valign="top">R</td><td align="center" valign="top">B3.1</td><td align="center" valign="top">PL, AL</td></tr><tr><td align="left" valign="top">10/F/45</td><td align="center" valign="top">R</td><td align="center" valign="top">B3.1</td><td align="center" valign="top">PL, AL</td></tr><tr><td align="left" valign="top">11/M/33</td><td align="center" valign="top">R</td><td align="center" valign="top">B3.1</td><td align="center" valign="top">PL, AL</td></tr><tr><td align="left" valign="top">12/M/42</td><td align="center" valign="top">L</td><td align="center" valign="top">B3.3</td><td align="center" valign="top">PL, AM</td></tr><tr><td align="left" valign="top">13/F/49</td><td align="center" valign="top">L</td><td align="center" valign="top">C3.1</td><td align="center" valign="top">PL ,AL,AM</td></tr><tr><td align="left" valign="top">14/F/68</td><td align="center" valign="top">L</td><td align="center" valign="top">B3.1</td><td align="center" valign="top">PL</td></tr><tr><td align="left" valign="top">15/M/58</td><td align="center" valign="top">L</td><td align="center" valign="top">B3.1</td><td align="center" valign="top">PL, AL</td></tr><tr><td align="left" valign="top">16/F/21</td><td align="center" valign="top">R</td><td align="center" valign="top">C3.2</td><td align="center" valign="top">PL, AM,PM</td></tr><tr><td align="left" valign="top">17/F/65</td><td align="center" valign="top">L</td><td align="center" valign="top">B3.1</td><td align="center" valign="top">PL, AL</td></tr><tr><td align="left" valign="top">18/F/69</td><td align="center" valign="top">L</td><td align="center" valign="top">B3.1</td><td align="center" valign="top">PL, AL</td></tr><tr><td align="left" valign="top">19/M/37</td><td align="center" valign="top">R</td><td align="center" valign="top">B3.1</td><td align="center" valign="top">PL, AL</td></tr><tr><td align="left" valign="top">20/M/57</td><td align="center" valign="top">L</td><td align="center" valign="top">B3.3</td><td align="center" valign="top">PL, AM</td></tr><tr><td align="left" valign="top">21/M/60</td><td align="center" valign="top">R</td><td align="center" valign="top">C3.1</td><td align="center" valign="top">PL, AL, AM</td></tr><tr><td align="left" valign="top">22/M/46</td><td align="center" valign="top">R</td><td align="center" valign="top">B3.1</td><td align="center" valign="top">PL</td></tr><tr><td align="left" valign="top">23/F/33</td><td align="center" valign="top">R</td><td align="center" valign="top">C1.3</td><td align="center" valign="top">PL, PM</td></tr><tr><td align="left" valign="top">24/M/49</td><td align="center" valign="top">L</td><td align="center" valign="top">C3.1</td><td align="center" valign="top">PL, AL, PM</td></tr><tr><td align="left" valign="top">25/F/54</td><td align="center" valign="top">L</td><td align="center" valign="top">B3.1</td><td align="center" valign="top">PL, AL</td></tr><tr><td align="left" valign="top">26/M/40</td><td align="center" valign="top">R</td><td align="center" valign="top">B3.1</td><td align="center" valign="top">PL</td></tr><tr><td align="left" valign="top">27/M/36</td><td align="center" valign="top">R</td><td align="center" valign="top">B1.1</td><td align="center" valign="top">PL</td></tr><tr><td align="left" valign="top">28/M/65</td><td align="center" valign="top">L</td><td align="center" valign="top">B1.1</td><td align="center" valign="top">PL, AL</td></tr><tr><td align="left" valign="top">29/F/66</td><td align="center" valign="top">R</td><td align="center" valign="top">C2.2</td><td align="center" valign="top">PL, PM</td></tr><tr><td align="left" valign="top">30/F/66</td><td align="center" valign="top">R</td><td align="center" valign="top">B3.1</td><td align="center" valign="top">PL, AL</td></tr><tr><td align="left" valign="top">31/M/44</td><td align="center" valign="top">R</td><td align="center" valign="top">B3.3</td><td align="center" valign="top">PL, AL</td></tr><tr><td align="left" valign="top">32/F/45</td><td align="center" valign="top">L</td><td align="center" valign="top">B3.1</td><td align="center" valign="top">PL, AL</td></tr><tr><td align="left" valign="top">33/F/50</td><td align="center" valign="top">L</td><td align="center" valign="top">B3.1</td><td align="center" valign="top">PL</td></tr><tr><td align="left" valign="top">34/F/53</td><td align="center" valign="top">L</td><td align="center" valign="top">B3.1</td><td align="center" valign="top">PL, AL</td></tr><tr><td align="left" valign="top">35/M/46</td><td align="center" valign="top">R</td><td align="center" valign="top">B3.1</td><td align="center" valign="top">PL, AL</td></tr><tr><td align="left" valign="top">36/M/43</td><td align="center" valign="top">R</td><td align="center" valign="top">C2.2</td><td align="center" valign="top">PL, AM, PM</td></tr></tbody></table></div><div class="ftSidebarText"></div></div></div></div><div id="articleTables" style="display: none;"><table class="ftFigure"><tr><td class="ftGraphicThumbnail"><a target="_blank" href="/web/20131027131211/http://www.healio.com/~/media/Journals/ORTHO/2013/10_October/10_3928_01477447_20130920_16/fig1.jpg"><img class="ftThumbnail" alt="Axial computed tomography scan at the subchondral level showing a posterolateral (PL) articular fragment. Point O is the center of the knee (midpoint of 2 tibial spines), point A is the anterior tibial tuberosity, point B is the posterior sulcus of the tibial plateau, point C is the most anterior point of the fibular head (F), and point D is the posteromedial (PM) ridge of the proximal tibia. Although a fracture line exists in the posteromedial quadrant (black arrow), the posteromedial cortex remains intact and a posteromedial fracture was excluded. Abbreviations: AL, anterolateral; AM, anteromedial." src="/web/20131027131211im_/http://www.healio.com/orthopedics/journals/ortho/%7B299aeed3-f143-43f6-b1b1-d58e6a9be98f%7D/~/media/Journals/ORTHO/2013/10_October/10_3928_01477447_20130920_16/fig1.jpg"></a></td><td class="ftFigureCaption"><p class="ftFloatLeft">Figure 1: </p><p class="ftFloatLeft">Axial computed tomography scan at the subchondral level showing a posterolateral (PL) articular fragment. Point O is the center of the knee (midpoint of 2 tibial spines), point A is the anterior tibial tuberosity, point B is the posterior sulcus of the tibial plateau, point C is the most anterior point of the fibular head (F), and point D is the posteromedial (PM) ridge of the proximal tibia. Although a fracture line exists in the posteromedial quadrant (black arrow), the posteromedial cortex remains intact and a posteromedial fracture was excluded. Abbreviations: AL, anterolateral; AM, anteromedial.</p></td></tr></table><table class="ftFigure"><tr><td class="ftGraphicThumbnail"><a target="_blank" href="/web/20131027131211/http://www.healio.com/~/media/Journals/ORTHO/2013/10_October/10_3928_01477447_20130920_16/table1.jpg"><img class="ftThumbnail" alt="Patient Demographics and Fracture Classification" src="/web/20131027131211im_/http://www.healio.com/orthopedics/journals/ortho/%7B299aeed3-f143-43f6-b1b1-d58e6a9be98f%7D/~/media/Journals/ORTHO/2013/10_October/10_3928_01477447_20130920_16/table1.jpg"></a></td><td class="ftFigureCaption"><p class="ftFloatLeft">Table: </p><p class="ftFloatLeft">Patient Demographics and Fracture Classification</p></td></tr></table><table class="ftFigure"><tr><td class="ftGraphicThumbnail"><a target="_blank" href="/web/20131027131211/http://www.healio.com/~/media/Journals/ORTHO/2013/10_October/10_3928_01477447_20130920_16/fig2.jpg"><img class="ftThumbnail" alt="Axial (A–C) and sagittal (D–F) computed tomography scans showing the methods of measuring the posterior femoral condylar axis (A), major articular fragment angle (B), articular surface area (C), sagittal fracture angle (D), maximum fracture height (E), and displacement (F). Abbreviations: PFCA, posterior femoral condylar axis." src="/web/20131027131211im_/http://www.healio.com/orthopedics/journals/ortho/%7B299aeed3-f143-43f6-b1b1-d58e6a9be98f%7D/~/media/Journals/ORTHO/2013/10_October/10_3928_01477447_20130920_16/fig2.jpg"></a></td><td class="ftFigureCaption"><p class="ftFloatLeft">Figure 2: </p><p class="ftFloatLeft">Axial (A–C) and sagittal (D–F) computed tomography scans showing the methods of measuring the posterior femoral condylar axis (A), major articular fragment angle (B), articular surface area (C), sagittal fracture angle (D), maximum fracture height (E), and displacement (F). Abbreviations: PFCA, posterior femoral condylar axis.</p></td></tr></table><table class="ftFigure"><tr><td class="ftGraphicThumbnail"><a target="_blank" href="/web/20131027131211/http://www.healio.com/~/media/Journals/ORTHO/2013/10_October/10_3928_01477447_20130920_16/fig3.jpg"><img class="ftThumbnail" alt="Histogram demonstrating distribution of the major posterolateral articular fragment angle (MAFA)." src="/web/20131027131211im_/http://www.healio.com/orthopedics/journals/ortho/%7B299aeed3-f143-43f6-b1b1-d58e6a9be98f%7D/~/media/Journals/ORTHO/2013/10_October/10_3928_01477447_20130920_16/fig3.jpg"></a></td><td class="ftFigureCaption"><p class="ftFloatLeft">Figure 3: </p><p class="ftFloatLeft">Histogram demonstrating distribution of the major posterolateral articular fragment angle (MAFA).</p></td></tr></table><table class="ftFigure"><tr><td class="ftGraphicThumbnail"><a target="_blank" href="/web/20131027131211/http://www.healio.com/~/media/Journals/ORTHO/2013/10_October/10_3928_01477447_20130920_16/fig4.jpg"><img class="ftThumbnail" alt="Histogram showing distribution of the maximum fracture height." src="/web/20131027131211im_/http://www.healio.com/orthopedics/journals/ortho/%7B299aeed3-f143-43f6-b1b1-d58e6a9be98f%7D/~/media/Journals/ORTHO/2013/10_October/10_3928_01477447_20130920_16/fig4.jpg"></a></td><td class="ftFigureCaption"><p class="ftFloatLeft">Figure 4: </p><p class="ftFloatLeft">Histogram showing distribution of the maximum fracture height.</p></td></tr></table><table class="ftFigure"><tr><td class="ftGraphicThumbnail"><a target="_blank" href="/web/20131027131211/http://www.healio.com/~/media/Journals/ORTHO/2013/10_October/10_3928_01477447_20130920_16/fig5.jpg"><img class="ftThumbnail" alt="Histogram demonstrating the distribution of the sagittal fracture angle." src="/web/20131027131211im_/http://www.healio.com/orthopedics/journals/ortho/%7B299aeed3-f143-43f6-b1b1-d58e6a9be98f%7D/~/media/Journals/ORTHO/2013/10_October/10_3928_01477447_20130920_16/fig5.jpg"></a></td><td class="ftFigureCaption"><p class="ftFloatLeft">Figure 5: </p><p class="ftFloatLeft">Histogram demonstrating the distribution of the sagittal fracture angle.</p></td></tr></table></div><div id="articleReferences" style="display: none;"><div class="ftRefList"><h3>References</h3><ol><a name="x01477447-20130920-16-bibr1"></a><li> Carlson DA. 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Tibio-femoral kinematics and condylar motion during the stance phase of gait. <i>J Biomech</i>. 2009; 42(12):1877–1884. doi:10.1016/j.jbiomech.2009.05.003 <a target="_blank" href="https://web.archive.org/web/20131027131211/http://dx.doi.org/10.1016/j.jbiomech.2009.05.003">[CrossRef]</a></li></ol></div></div><p>10.3928/01477447-20130920-16</p></div></div></div></div> <script type="text/javascript" language="javascript"> var $artContent = $('.ftArticle').html(); $('#anchor-tab-abstract').click(function () { $('#articleBody, #articleTables, #articleReferences').hide(); $('#abstractPortion').show(); var current = $('a.current').removeClass('current'); $(this).addClass('current'); }); $('#anchor-tab-article').click(function () { $('#articleReferences, #articleTables').hide(); $('#articleBody, #abstractPortion').show() var current = $('a.current').removeClass('current'); $(this).addClass('current'); }); $('#anchor-tab-figures').click(function () { $('#articleBody, #abstractPortion, #articleReferences').hide(); $('#articleTables').show(); var current = $('a.current').removeClass('current'); $(this).addClass('current'); }); $('#anchor-tab-refs').click(function () { $('#articleBody, #abstractPortion, #articleTables').hide(); $('#articleReferences').show(); var current = $('a.current').removeClass('current'); $(this).addClass('current'); }); </script> <div class="social-links"> <div class="fb-like" data-send="false" data-width="300" data-show-faces="true" data-action="recommend"></div> <ul class="share"> <li><a href="javascript:void(0)" id="twitter" class="twitter-link" target="_new">Tweet</a></li> <li><a href="javascript:void(0)" id="facebook" class="facebook-link" target="_new">Share</a></li> <li class="linkedin"><a href="javascript:void(0)" id="linkedin" class="linkedin-link">Link</a></li> <li><span class="db-wrapper"><span class="g-plusone" data-size="tall" data-annotation="none"></span></span></li> <li><a href="javascript:void(0)" id="email">Email</a></li> <li class="last"><a href="javascript:void(0)" id="print">Print</a></li> </ul> <input name="layout_0$maincontent_3$articleItemForTweet" type="hidden" id="layout_0_maincontent_3_articleItemForTweet" value="{6B61BF7D-9C6C-466F-820E-B8AAC0A91C5A}"/> <input name="layout_0$maincontent_3$tweettext" type="hidden" id="layout_0_maincontent_3_tweettext" class="tweettext" value="This Issue: Borderline Personality Disorder "/> <input name="layout_0$maincontent_3$tweeturl" type="hidden" id="layout_0_maincontent_3_tweeturl" class="tweeturl" value="http://goo.gl/BPntfF"/> </div> <div id="respond"> <h4> Comments</h4> <script language="javascript" type="text/javascript"> var idcomments_acct = 'aa6ff53f9870e40f92f83e1b5df3cddf'; var idcomments_post_id = '299aeed3-f143-43f6-b1b1-d58e6a9be98f'; var idcomments_post_url; </script> <span id="IDCommentsPostTitle" style="display: none"></span> <script type="text/javascript" src="https://web.archive.org/web/20131027131211js_/http://www.intensedebate.com/js/genericCommentWrapperV2.js"></script> <p class="comment-notes"> Healio is intended for health care provider use and all comments will be posted at the discretion of the editors. 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Morphological Characteristics of Posterolateral Articular Fragments in Tibial Plateau Fractures | Orthopedics