Patient function continues to improve over the first five years following tibial plateau fracture managed by open reduction and internal fixation

Abstract

Aims Tibial plateau fractures are serious injuries about the knee that have the potential to affect patients’ long-term function. To our knowledge, this is the first study to use patient-reported outcomes (PROs) with a musculoskeletal focus to assess the long-term outcome, as compared to a short-term outcome baseline, of tibial plateau fractures treated using modern techniques. Methods In total, 102 patients who sustained a displaced tibial plateau fracture and underwent operative repair by one of three orthopaedic traumatologists at a large, academic medical centre and had a minimum of five-year follow-up were identified. Breakdown of patients by Schatzker classification is as follows: two (1.9%) Schatzker I, 54 (50.9%) Schatzker II, two (1.9%) Schatzker III, 13 (12.3%) Schatzker IV, nine (8.5%) Schatzker V, and 26 (24.5%) Schatzker VI. Follow-up data obtained included: Visual Analogue Scale (VAS) or Numeric Rating Scale (NRS) pain scores, Short Musculoskeletal Functional Assessment (SMFA), and knee range of movement (ROM). Data at latest follow-up were then compared to 12-month data using a paired t-test. Results Patient-reported functional outcomes as assessed by overall SMFA were statistically significantly improved at five years (p < 0.001) compared with one-year data from the same patients. Patients additionally reported an improvement in the Standardized Mobility Index (p < 0.001), Standardized Emotional Index (p < 0.001), as well as improvement in Standardized Bothersome Index (p = 0.003) between the first year and latest follow-up. Patient-reported pain and knee ROM were similar at five years to their one-year follow-up. In total, 15 of the patients had undergone subsequent orthopaedic surgery for their knees at the time of most recent follow-up. Of note, only one patient had undergone knee arthroplasty following plateau fixation related to post-traumatic osteoarthritis (OA). Conclusion Knee pain following tibial plateau fracture stabilizes at one year. However, PROs continue to improve beyond one year following tibial plateau fracture, at least in a statistical sense, if not also clinically. Patients displayed statistical improvement across nearly all SMFA index scores at their minimum five-year follow-up compared with their one-year follow-up. Cite this article: Bone Joint J 2020;102-B(5):632–637.

Anti-gravity treadmill rehabilitation improves gait and muscle atrophy in patients with surgically treated ankle and tibial plateau fractures after one year: A randomised clinical trial

“…We found no differences in the range of motion between the intervention and control groups overall and between the ankle and tibial plateau fracture subgroups, our results are in line with other studies that reported the range of motion of the ankle and knee. [32][33][34][35][36] Our findings should be interpreted within the limitations of this study. The main limitation was the significant proportion of patients who dropped out.…”

“…We found no differences in the range of motion between the intervention and control groups overall and between the ankle and tibial plateau fracture subgroups, our results are in line with other studies that reported the range of motion of the ankle and knee. 32–36…”

Tibial plateau fractures in older adults are associated with a clinically significant deterioration in health-related quality of life

“…Previous studies of functional outcomes following TPF specifically have used a number of different PROMs. Gonzalez et al 19 reported Short Musculoskeletal Functional Assessment (SMFA) scores at one and > five years in 138 patients with operatively managed TPFs. They reported a statistically significant improvement in mean scores in all SMFA domains except pain from one- to > five-year follow-up.…”

Recovery Curve for Patients With Pilon Fractures Using Patient-Reported Outcome Measurement Information System

“…Foot and Ankle Ability Measure median score was 74% of full function, which is similar to our results using PROMIS PF. Comparative literature in other lower extremity fractures is sparce, but Gonzalez et al 10 published on 1- and 5-year outcomes of tibial plateau fractures showing continued improvement throughout the time frame. This suggests that there is likely differences in the recovery of various lower extremity fractures that deserves further investigation.…”