Medium-Term Results after Surgical Treatment of High-Energy Tibial Plateau Fractures

Abstract

The aim of the article is to present the medium-term results of surgical treatment of Schatzker's IV, V, and VI tibial plateau fractures, in a retrospective study of 22 patients at a level-1 trauma center. Twenty-two of 34 patients with Schatzker's IV–VI fractures completed follow-up at a mean of 56 months (range: 7–103 months). Patients' mean age was 47.6 years (range: 18–76 years). Open reduction and internal fixation were performed in 16 patients, while external fixators were used in the remaining six patents. Patients were assessed radiologically for the presence of arthritis using the Kellgren–Lawrence scale. Functional outcomes were measured using the Lysholm's knee score, knee injury, and osteoarthritis outcome score (KOOS). Quality of life was also assessed postoperatively using the EuroQol-5D (EQ-5D) form and EQ-VAS (visual analogue scale) score. There were no postoperative infections and no fracture went on to nonunion. Absence of arthritic change was noted in only 6.3% of cases. The average KOOS score was 80 and the average Lysholm's score was 84.91. Regarding the postoperative quality of life, mobility was impaired in 45.5%, self-care in 27.3%, and usual activities in 36.3% of patients. Pain or discomfort was reported in 77.2% and anxiety or depression in 40.9% of cases. The mean VAS score was 77.8. Eighty percent of patients had returned to their previous activities at the time of last follow-up. Although complex tibial plateau fractures are associated with a high rate of complications and can have a severe impact on the injured knee, most patients had quite satisfactory results during their medium-term clinical evaluation, in our study. It is a Level IV case series study.

Patients with complex proximal tibial fractures overestimate the prognosis of their injury

“…They found out that after proximal tibial fracture mean NRS (numeric rating scale) was 4.5, IKDC (International Knee Documentation Committee Subjective Knee Form) score was 50.46, and the EQ 5D (European Quality of Life 5 Dimensions) was 7.47.In the presented study more than 47% of the patients in both groups expected at most occasional pain when participating in demanding sports. Comparing the results of the study to the existing literature, expectation for residual pain was overestimated [11,13,14]. Additionally, regarding the HFSS-KSE items, restoring knee function and full range of motion had highest patient priority.…”

“…In this study, most patients expected residual pain at most occasionally during demanding sports. In a study by Evangelopoulos et al evaluating mid-term results after proximal tibial fracture, 77% of the patients reported pain or discomfort in the affected knee joint within 56 months (mean) after proximal tibial fracture [11]. Severe injury of the tibia frequently leads to residual pain or limited knee function [12].…”

Impact of Surgical Site Infection To Outcome In Patients With Operatively Treated Tibial Plateau Fractures– A Retrospective Multicenter Study

“…[6] Our results of the whole group in the KOOS subscores are comparable with the results of other studies. [5][6][7]17] Finally, a signi cant negative in uence of the SSI was found in Lysholm, KOOS5 and in four of ve KOOS subscores. With regard to pain, symptoms, ADL and QoL the long hospital stay with the associated changes in terms of atrophy…”

“…In general a return to sport is often very di cult after TPF as also shown in other studies and may explain why there was no difference between the groups. [5][6][7] Also the Lysholm Score con rmed the negative in uence of an infection on the outcome.…”

“…[4] Focus of the most studies is to evaluate the generell outcome of tibial plateau fractures. [5][6][7][8] The aim of the here presented study was to evalute the impact of SSI on the outcome after operatively treated TPF measured with patient reported outcome scores.…”