Radiographic and clinical results after surgically treated tibial plateau fractures at three and twenty two years postsurgery

Abstract

Purpose We examined the development of osteoarthritis (OA) and post-traumatic bone loss after surgery for tibial plateau fractures (TPF). Methods Patients who had participated in previous follow-up (FU) examinations after TPF and primary reduction and internal fixation were re-evaluated. At the first FU, a median of three years after the accident (short-term FU), the patients underwent functional assessments and standardised X-rays to grade radiological OA and post-traumatic bone loss. At the second FU, a median of 22 years after the accident (long-term FU), 30 patients were available. An identical protocol was applied, and additional investigations [Knee Injury and Osteoarthritis Outcome Score (KOOS) and magnetic resonance imaging (MRI) of the injured knee] were performed. Results When the subjective and objective results at first FU were compared with those of the second FU for the same patients, deterioration of symptoms, signs and radiological OA was noted; however, ten patients had no OA even after the long-term FU. Some patients developed post-traumatic bone loss. In 13 of 31 knees, there was little or no radiological evidence of bone loss at the second FU. Conclusions The short-term FU examination results after TPF have little prognostic value for the individual patient, as good results may deteriorate over the long run; however, there were some knees with no OA at the long-term FU. This is the first report focusing on post-traumatic bone loss after TPF.

Comparison of the pre-shaped anatomical locking plate of 3.5 mm versus 4.5 mm for the treatment of tibial plateau fractures

“…In our series, the observed rates were comparable. Clinical results seen in the literature are comparable to ours, emphasizing the severity of these lesions and the absolute necessity of a quality reduction [31,32]. Mobility and functional scores that we reported were satisfying and identical irrespective of the type of plate.…”

“…To our knowledge, the clinical tolerance of locking plates was rarely studied, even though this was discusses by Hasan et al [11]. The different studies showed at the most the number of material ablations, with different figures ranging from 5 to 11 % [14,17,[25][26][27][28][29][30][31][32][33][34][35][36]. Concerning clinical tolerance, our hypothesis was confirmed with a better clinical tolerance for 3.5-mm plates, which has never been discussed in the literature.…”

Mid- to long-term functional outcome after open reduction and internal fixation of tibial plateau fractures

“…Osteoarthritis was present in 40.6% of all patients, even as high as 57.5% in bicondylar fractures, and in 7.3% total knee arthroplasty was eventually required. Comparable results of OA [7][8][9][10][11][12][13] and total knee arthroplasty [15,27,28] are found in the literature.…”

“…Incidences of OA after tibial plateau fractures vary in literature between 10% and 58% [7][8][9][10][11][12][13]. Patients often present with limbspecific and general health deficits at follow-up [5].…”

Treatment strategy for tibial plateau fractures: an update

“…47 In this group, persistent pain is related to high-energy trauma injuries. Another study 48 comparing OA signs at 3 and at 22 years in a group of 31 patients with surgically treated TPF, showed that there is a deterioration of radiological OA signs between 3 and 22 years of follow-up and that there are differences in the evolution of the OA signs between the operated and the healthy knee in the same patient. TKA was required in 13% of patients in this study.…”