Morphological study of proximal fibular fractures with concomitant tibial plateau fractures: An investigation of 223 cases

ObjectiveThis study aimed to systematically characterize the morphological patterns of proximal fibular fractures occurring concurrently with tibial plateau fractures.MethodsData were retrospectively collected from a Level-1 trauma center between January 2011 and January 2024 by querying hospital information and picture archiving and communication systems with keywords "tibial plateau fracture" and "fibular fracture" or "fibular head fracture." Radiographic morphology was evaluated using standard anteroposterior radiographs and three-dimensional computed tomography (3D-CT), categorizing proximal fibular fractures into 13 predefined morphological patterns. Descriptive data, including fracture location, number of fragments, and degree of displacement, were recorded and classified. The distribution patterns of proximal fibular fractures were further correlated with the tibial plateau fractures, categorized according to the CT-based three-column classification system.ResultsA total of 223 eligible patients (123 males) were included in the analysis. Group I, II, and III proximal fibular fractures were observed in 63 (28.3%), 121 (54.3%), and 39 (17.4%) patients, respectively. Within group II, subtype II3p was the predominant fracture pattern, occurring in 61 patients (50.4%). Group I fibular fractures did not occur in tibial plateau posterior column or combined lateral and posterior column fractures. Group II fibular fractures were absent in tibial plateau lateral column or combined medial and lateral column fractures. Group III fibular fractures exclusively presented with combined lateral and posterior column or three-column tibial plateau fractures. Logistic regression indicated that group I proximal fibular fractures were significantly more associated with isolated medial column tibial plateau fractures, whereas group II fibula fractures were significantly associated with lateral-posterior and medial-posterior column tibial plateau fractures.ConclusionsThe morphological diversity observed in proximal fibular fractures underscores the complexity and heterogeneity of concomitant tibial plateau fractures. Further clinical and biomechanical investigations are warranted to elucidate the pathomechanics underlying comminuted fibular fractures associated with tibial plateau injuries.