Epidemiological characteristics of medial tibial plateau fractures and effects of two surgical methods for Wahlquist type C fractures

To explore the epidemiological characteristics of medial tibial plateau fractures and compare the clinical outcomes of two surgical methods for Wahlquist type C fractures. Data of 132 patients with medial tibial plateau fractures who were treated in our hospital from August 1, 2013, to August 1, 2023, were retrospectively collected and analyzed epidemiologically. Among them, 59 patients with Wahlquist type C fractures fixed with double incisions and double plates on the inside and outside of the knee were treated with two surgical methods: the method of prioritizing the treatment of impacted bone fragments between the tibial condyles (group 1) and the method of non-prioritizing the treatment of impacted bone fragments between the tibial condyles (group 2), and were followed up. The surgical time, intraoperative blood loss, fracture healing time, excellent and good rate of postoperative bone fragment reduction, postoperative varus deformity rate of the knee, instability rate of the lateral tibial plateau, incidence rate of postoperative incision complications, and excellent and good rates of postoperative knee joint function were compared between the two surgical methods. A total of 132 patients had medial tibial plateau fractures, accounting for 10.2 % of all tibial plateau fractures during the same period. This study included 74 male and 58 female patients. Among the patients, 12 (9.1 %) were aged >20–≤30 years, 41 (31.1 %) were aged >30–≤40 years, 43 (32.6 %) were aged >40–≤50 years, 26 (19.7 %) were aged >50–≤60 years, 6 (4.5 %) were aged >60–≤70 years, and 4 (3 %) were aged >70–≤80 years. Patients aged >30–≤60 years had a high incidence of medial tibial plateau fractures (83.3 %), and the incidence rate was the highest among those aged >30–≤50 years (63.6 %). Among patients aged ≤60 years, 57.4 % (70/122) were men and 42.6 % (52/122) were women. Among patients aged >70 years, 25 % (1/4) were men, and 75 % (3/4) were women. There were 71 cases (53.8 %) of traffic accident injuries, 41 (31.1 %) of electric scooter falls, 9 (6.8 %) of falls from heights, 8 (6.1 %) of being hit by heavy objects, and 3 (2.3 %) of other injuries. There were 71 (53.8 %) Wahlquist type C fractures, >40 (30.3 %) Wahlquist type B fractures, and >21 (15.9 %) Wahlquist type A fractures. The incidence rate of soft tissue injuries (collateral ligaments, cruciate ligaments, menisci, popliteal vessels, and nerve injuries) of the knee joint in patients with Wahlquist type C fractures of the medial tibial plateau was 78.9 %, which was much higher than that in patients with Wahlquist types B (35.0 %) and A (19.0 %) (P < 0.05). Fifty-nine patients with Wahlquist type C fractures were treated with the method of prioritizing (group 1) or non-prioritizing (group 2) the treatment of impacted bone fragments between the tibial condyles and double-incision double-plate internal fixation on the inside and outside of the knee. The mean follow-up period was 36.1 ± 11.6 (range, 13 to 128) months. The excellent and good rate of bone fragment reduction and knee joint function score in group 1 were significantly higher than those in group 2, and the postoperative varus deformity rate of the knee and instability rate of the lateral tibial plateau were significantly lower than those in group 2, with statistically significant differences (P < 0.05). However, there were no statistically significant differences in surgical time, intraoperative blood loss, fracture healing time, and surgical incision complication rate between the two groups (P > 0.05). Medial tibial plateau fractures are more common in men aged ≤60 years and women aged >70 years. The age group >30–≤60 years had a high incidence of medial tibial plateau fractures, and the incidence rate of medial tibial plateau fractures was the highest among those aged >30–≤50 years. Traffic accidents and electric scooter falls were the most common causes of medial tibial plateau fracture. Wahlquist type C fractures of the medial tibial plateau had the highest rate of associated soft tissue injuries. Open reduction and double-plate screw internal fixation with prioritized treatment of the impacted bone fragments between the tibial condyles could achieve satisfactory therapeutic effects. Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. • Schatzker type IV fractures of the tibial plateau are more common in young and middle-aged men. igh-energy injury is the main cause. • Collapse of posterolateral condyle, bone fragment impingement, subluxation of the knee are their typical characteristics. • Prioritizing the treatment of intercalated bone fragments do good to Wahlquist type C fractures of the medial tibial plateau.