Eur J Trauma Emerg Surg. 2026 May 6;52(1):159. doi: 10.1007/s00068-026-03207-3.
ABSTRACT
PURPOSE: Tibial plateau fractures (TPF) are often associated with non-bony injuries that may impair knee stability and long-term outcomes. However, it remains unclear in which patients preoperative MRI is indicated to detect these injuries, and clear recommendations for surgical decision making are lacking. This study aimed to develop a CT-based predictor of surgically relevant non-bony injuries.
METHODS: This retrospective single-center study included all intra-articular TPF treated between January 2022 and May 2025 at a Level I trauma center. Fractures were classified according to the 10-segment and three-column classifications. Operative reports were reviewed to identify non-bony injuries requiring surgical treatment. Descriptive statistics and multivariate logistic regression were performed to determine predictors of surgically relevant non-bony injuries.
RESULTS: Among 243 patients (mean age 49,3 ± 14,9 years), 34,6% had at least one surgically treated non-bony injury. Posterior column involvement was significantly associated with a higher injury rate (41,4%), particularly affecting meniscus (20,7%), Anterior cruciate ligament (ACL) (17,2%), and medial collateral ligament (MCL) (12,3%). The posterolateral-central (PLC) segment showed the highest segment-specific injury rate (37,6%) and was an independent predictor of ACL injury. Increasing fracture complexity was associated with a higher incidence of soft tissue injuries.
CONCLUSION: TPF should be regarded as complex intra-articular injuries rather than simple bone fractures. This study provides a CT-based tool to identify fracture patterns associated with surgically relevant non-bony injuries. These findings may support indications for preoperative MRI, guide treatment strategies, and help prevent poor outcomes and post-traumatic osteoarthritis.
PMID:42090008 | DOI:10.1007/s00068-026-03207-3
