Immediate Knee Joint Range of Motion after Stable Fixation of Tibial Plateau Fractures

Abstract

The purpose of this study was to evaluate factors that affect initiation of early postoperative range of motion (ROM) rehabilitation and to investigate whether the postoperative ROM and clinical outcomes were affected by initiation of early ROM, immobilization and other factors. We conducted a retrospective analysis of tibial plateau fractures treated using stable internal fixation between December 2003 and June 2007. The resulting degree of flexion and Rasmussen Clinical and Radiographic Scores were evaluated. Thirty-nine patients were included, and 23 patients underwent a lateral submeniscal arthrotomy for evaluation of joint surface reduction, with 6 lateral meniscus lesions identified via arthrotomy. Three lateral collateral ligament lesions, 3 medial collateral ligament lesions and 1 anterior cruciate ligament lesion were found. Meniscus and ligament lesions significantly and negatively affected the initiation of knee joint ROM. Early ROM was achieved in 26 cases and 13 patients underwent immobilization for 4 weeks. At the final evaluation, the early ROM group had 130.42˚ ± 5.50˚ of flexion, compared with 122.92˚ ± 5.28˚ in the immobilization group. Moreover, the final Rasmussen score was 25.69 ± 2.92 in the early motion group, compared with 22.61 ± 3.5 in the immobilization group. There was no difference between radiographic scores of the groups. Although the initiation of early ROM improved the clinical results, soft tissue lesions influenced initiation of early knee joint motion. Therefore, meniscus and ligament injuries should be considered as prognostic factors in similar cases.

Case Series of Tibial Plateau Fracture Treated Using Illizarov External Fixator – Functional and Radiological Outcome

“…The reason for his low KOOS score was mainly due to poor motivation, social support and poor compliance to physiotherapy. All of our patient unable to achieve full knee flexion which correspond to the study by Arslan A et al where despite of immediate range of motion after stable internal fixation still unable to achieve full range of motion (6). Similar result was also reported by IR Ranatunga et all treated his patients with tibia plateau fractures using illizarov external fixator (14).…”

“…All of our patients have less than 5mm of condylar widening and less than 10 degree of Varus/Valgus angulation. Our outcome of radiological assessment are comparable to other studies using IEF or internal implants (5,6). Mao et al reported there is no difference in the radiological score when assessment was done at 3 months and 12 months (13).…”

“…Similar result was also reported by IR Ranatunga et all treated his patients with tibia plateau fractures using illizarov external fixator (14). This inability to achieve full range of motion most likely due to the soft tissue injury such as meniscus and cruciates ligament injury that hinder the efficient early range of motion post operatively (6). The compliance itself to physio and self-motivation is also very important as early range of motion and weight bearing are really dependent on the patient's own initiative.…”

“…For those that unable to come, we referred them to the nearest centre for their physio follow up. The patients were assessed functionally using Knee Injury and Osteoarthritis Outcome Scores (KOOS) and radiologically using Rasmussen radiological score during the 1st month follow up after removal of the Ilizarov frame (6,7).…”

Case Report: Standard rehabilitation protocol for complex tibial plateau fracture associated with fibular head fracture managed with plate osteosynthesis

“…The prevalence of these fractures comprises around 1.2 percent of all fractures and is often higher among young individuals who have had high-energy trauma. 3 Most older people who have had low-energy trauma are also affected by them. 3 According to the Schatzker classification, there are six different types of tibial plateau fractures: lateral plateau fractures without depression (type I), lateral plateau fractures with depression (type II), compression fractures of the lateral or central plateaus (type IIIA or IIIB), medial plateau fractures (type IV), bicondylar plateau fractures (type V), and plateau fractures with diaphyseal discontinuity (type VI).…”