| Tibial plateau fractures,a type of intra-articular fracture in which the fracture lines involve the proximal end of the tibia.In recent years,with the development of industrialization and urbanization,the incidence of tibial plateau fractures has been gradually increased.According to various literature reports,it represented 1-4% of all fractures and approximately 8% of fractures in the elderly.Tibial plateau fractures belongs to intra-articular fractures,and the types of injuries are complex and diverse,which can easily lead to complications such as traumatic arthritis and need high quality treatment.Fracture classification is widely used in orthopedics clinical and academic communication.The correct classification can not only reflect the severity of injury,standardize the fracture diagnosis,facilitate the treatment and operation plan,and is the basis of evaluating therapeutic effect and describe fracture prognosis,but also provides a reference standard for the academic exchanges among scholars.If the fracture types are different,then the treatment methods and effects are not the same.A variety of tibial plateau fracture classification systems and classification methods have been developed in the history,including Schatzker classification system,AO/OTA classification system,Hohl and Moore classification system,Three-column classification system and so on.Among them,Schatzker classification system and AO/OTA classification system have been widely used in statistics trauma data and paper publishing of tibial plateau fracture,and gradually become the two standard and widely accepted classification methods of tibial plateau fractures.Presently,the study of adult tibial plateau fractures clinical characteristics in the worldwide are not sufficient,especially the epidemiology characteristics study has not been reported.China is the largest developing country in the world,and Shaanxi is located in the northwest of China,its economic development is relatively backward to the middle east.It is well known that the epidemiological characteristics of diseases are affected by many factors,such as natural geographical environment,social production life,economic development level,and so on.The different natural,economic and social environments to other countries or regions may lead to the different epidemiological characteristics of the disease in this region.The systematic study of the characteristics of tibial plateau fractures in this region is helpful to understand the disease more deeply and widely,which can provide the latest information of clinical characteristics,and provide scientific reference for the formulation of national health policy.Moreover,some fractures were difficult to classify using the Schatzker classification or AO/OTA classification,but have not been systematically and deeply studied.previously.In addition,although the Schatzker classification system and AO/OTA classification system are the most two common tibial plateau fractures classification methods,but the evaluation consistency of these two classification systems,namely the validity and reliability of the two methods are not conclusive.Systematically study the evaluation consistency of these two classification systems can help to select the best classification system,and can provide references for the clinical application and scientific research of the tibial plateau fractures classification systems.Objectives1.Clinical characteristics of adult tibial plateau fractures with AO/OTA classification system.2.Further study the clinical characteristics of adult tibial plateau fractures after incorporating the patients’ epidemiology factors.At the same time,the typing coincidence rate of Schatzker classification system and AO/OTA classification system,and the clinical characteristics of difficult classify fractures were studied.3.Study the evaluation consistency of Schatzker classification system and AO/OTA classification system.Methods1.Research on clinical characteristics of adult tibial plateau fractures in the First Affiliated Hospital of the Fourth Military Medical University with AO/OTA classification.All cases were collected in the First Affiliated Hospital of The Fourth Military Medical University from September 2006 to August 2015.Then the patient’s age,genders and admission period were queried and recorded.Get the digital fracture images,and the tibial plateau fractures were classified by AO/OTA classification system of proximal tibial fractures.All cases were grouped according to the patient’s age,gender,admission period and type of fractures.The constituent ratio of type 41-B fractures and type 41-C fractures,gender ratio of different age group patients,age groups ratio in different admission period groups,as well as the gender ratio in different admission period groups were analyzed.2.Research on clinical characteristics of unilateral tibial plateau fractures among adult patients hospitalized in the First Affiliated Hospital of The Fourth Military Medical University.The weight of unilateral fractures and bilateral fractures were different,and most of the patients were unilateral tibial plateau fracture patients.In addition,some fractures were found difficult to classify using the Schatzker classification or AO/OTA classification in the first part of our study.Therefore,we only included unilateral tibial plateau fractures tofurther study the clinical characteristics of tibial plateau fractures.All cases of unilateral tibial plateau fractures among adult inpatients were collected in the First Affiliated Hospital of the Fourth Military Medical University from September2006 to August 2015.The data of epidemiology factors including the patient’s age,gender,side of lesion,admission period,admission season,type of employment,external cause and urban-rural residents,were queried and recorded.By collecting the digital fracture images,and the tibial plateau fractures were classified by the Schatzker classification system for tibial plateau fractures and the AO/OTA classification system for proximal tibia and fibula fractures.All cases were grouped according to the patient’s age,gender,side of lesion,admission period,admission season,type of employment,external cause,urban-rural residents,type of Schatzker classification and type of AO/OTA classification.Then the constituent ratio of tibial plateau fractures caused by different external causes were analyzed.3.Research on the evaluation consistency of Schatzker classification system and AO/OTA classification system for tibial plateau fractures.The initial classification was performed by two orthopedic surgeons according to Schatzker classification system and AO/OTA classification system.The second classification was completed after two months,which was classified under disrupting the case order and hiding the initial results.The classification results were recorded,then the evaluation consistency of the two classification systems was analyzed by the reliability and validity values.Results1.From September 2006 to August 2015,there was no significant difference in the ratio of type 41-B and type 41-C fractures between different admission period groups,age groups,males and females.There was also no significant difference in the ratio of different age groups,males and females between different admission period groups.While,Significant differences between male and female patients were observed among patients indifferent admission period groups.2.From September 2006 to August 2015,traffic accident injuries,falls and indoor activity injuries,and falls from height injuries were the three most common external cause of adult tibial plateau fractures in the First Affiliated Hospital of The Fourth Military Medical University,Xi’an,China.The male and female patients accounted for 71.5% and28.5%,respectively.Office worker,physical labourers,and other nature patients accounted for 23%,62%,and15%,respectively.Urban residents and rural residents account for 44.9% and 55.1%,respectively.According to the Schatzker classification system,simple fractures,complex fractures,and difficult to classify fractures accounted for 56.9%,31.4%,and 11.7% of tibial plateau fractures,respectively.Based on the AO/OTA classification system,type 41-B fractures,type 41-C fractures,and the difficult to classify group accounted for 56.9%,28.8%,and 14.2% of cases,respectively.The external causes of tibial plateau fractures varied significantly between males and females,types of employment,urban and rural residents,the Schatzker classification groups and the AO/OTA types.There was no significant difference in the distribution of external causes between different age groups,admission periods,admission seasons and right-and left-sided tibial plateau fractures.In addition,some fractures(about 11-15%)were difficult to classify using Schatzker or AO/OTA classification system.3.In the reliability assessment,the intra-observer reliability of both the Schatzker classification system and AO/OTA classification system were “excellent”,and both of the inter-observer reliability were over “substantial”.Both the inter-observer and inter-observer reliability assessment kappa values of Schatzker classification system were higher than that of AO/OTA classification system.As for validity assessment,the average agreement of Schatzker classification system and AO/OTA classification system were86.1% and 81.6%,respectively.Conclusions1.The number of patients treated in the First Affiliated Hospital of The Fourth Military Medical University from September 2006 to August 2015 showed a graduallyupward trend.Based on the AO/OTA classification system,type 41-B fractures were the mainly fracture types.There were more males than females.The high incidence age group was 30-59 years old.The male to female ratio of more than 60 years old group was less than 30-44 years and 45-59 years old group.2.According to the patients in the First Affiliated Hospital of The Fourth Military Medical University from September 2006 to August 2015,rural male physical labourers aged between 30-59 years-old were most likely to suffer from unilateral tibial plateau fractures,due to traffic accidents,falls and indoor activity injuries,or falls from height.Schatzker type Ⅱ fractures and AO/OTA type 41-B3 fractures were the most common types.We should pay more attention to the related people and professions,which contributed to the high occurrence of tibial plateau fractures in this cohort.Besides that,further improvements are required for both Schatzker and AO/OTA classification systems.3.Both Schatzker and AO/OTA classification systems are suitable for tibial plateau fractures classifications.However,the reliability and validity of the Schatzker classification system were better than those of the AO/OTA classification system.It is believed that the evaluation consistency of Schatzker classification system is better than that of AO/OTA classification system. |
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