Mapping recovery in simple and complex tibial plateau fracture fixation

Abstract

Aims The aim of this study was to determine the trajectory of recovery following fixation of tibial plateau fractures up to five-year follow-up, including simple (Schatzker I-IV) versus complex (Schatzker V-VI) fractures. Patients and Methods Patients undergoing open reduction and internal fixation (ORIF) for tibial plateau fractures were enrolled into a prospective database. Functional outcome, using the 36-Item Short Form Health Survey Physical Component Summary (SF-36 PCS), was collected at baseline, six months, one year, and five years. The trajectory of recovery for complex fractures (Schatzker V and VI) was compared with simple fractures (Schatzker I to IV). Minimal clinically important difference (MCID) was calculated between timepoints. In all, 182 patients were enrolled: 136 (74.7%) in simple and 46 (25.3%) in complex. There were 103 female patients and 79 male patients with a mean age of 45.8 years (15 to 86). Results Mean SF-36 PCS improved significantly in both groups from six to 12 months (p < 0.001) and one to five years (simple, p = 0.008; complex, p = 0.007). In both groups, the baseline scores were not reached at five years. The SF-36 PCS was significantly higher in the simple group compared with the complex group at both six months (p = 0.007) and 12 months (p = 0.01), but not at five years (p = 0.17). Between each timepoint, approximately 50% or more of the patients in each group achieved an MCID in their score change, indicating a significant clinical change in condition. The complex group had a much larger drop off in the first six months, with comparable proportions achieving MCID at the subsequent time intervals. Conclusion Tibial plateau fracture recovery was characterized overall by an initial decline in functional outcome from baseline, followed by a steep improvement from six to 12 months, and ongoing recovery up to five years. In simple patterns, patients tended to achieve a higher functional score by six months compared with the complex patterns. However, comparable functional scores between the groups achieved only at the five-year point suggest later recovery in the complex group. Function does not improve to baseline by five years in either group. This information is useful in counselling patients about the course of prospective recovery. Cite this article: Bone Joint J 2019;101-B:1009–1014.

Management of unicondylar tibial plateau fractures: a review

“…20 It can take up to 5 yr postoperatively for patients with medial condylar injuries to report equivalent clinical outcome to those with injury to the lateral plateau. 20 Patients with medial condylar injury, therefore, require appropriate counseling for what to expect in the process of recovery.…”

“…21 A large proportion of patients with type I to III injuries experience significant clinical improvement by 6 mo postoperatively, whereas type IV injuries often can require up to 12 mo before significant clinical improvement is realized. 20 It can take up to 5 yr postoperatively for patients with medial condylar injuries to report equivalent clinical outcome to those with injury to the lateral plateau. 20 Patients with medial condylar injury, therefore, require appropriate counseling for what to expect in the process of recovery.…”

Long-Term Trajectory of Recovery Following Pilon Fracture Fixation

“…Previous research has highlighted the trajectory of recovery following orthopaedic injuries as being neither short-term nor complete, by 1–2 years post-injury. 4–6…”

“…Previous research has highlighted the trajectory of recovery following orthopaedic injuries as being neither short-term nor complete, by 1-2 years post-injury. [4][5][6] The purpose of this prospective cohort study was to determine the trajectory of recovery following open reduction and internal fixation (ORIF) of pilon fractures over multiple longitudinal time points (baseline, 6 months, 1 year, and 5 years) and to establish the levels of long-term physical and mental disability related to these serious and complex injuries.…”

Quantifying Urinary and Sexual Dysfunction After Pelvic Fracture

“…In addition, recent publications in longitudinal recovery have highlighted how a single time-point of follow-up provides a limited view of the overall length and recovery of functional outcomes in pelvic fractures and other major musculoskeletal injuries. [35][36][37] Longitudinal studies on the trends in urinary and sexual dysfunction over time in pelvic fracture populations are lacking. As most patients with pelvic trauma are younger with a significant life expectancy, it is necessary to understand the prevalence, associations, and expectations for urinary and sexual function in pelvic fracture patients over time.…”