Worse Quality of Life Associated with Hyperextension Varus Tibial Plateau Fracture Pattern

Abstract

OBJECTIVES: Compare patient reported outcome measures (PROMs) between hyperextension varus tibial plateau (HEVTP) fractures to non-HEVTP fracture patterns METHODS: Design: Retrospective Setting: Single academic Level 1 Trauma Center Patient Selection Criteria: All patients who underwent fixation of a tibial plateau fracture from 2016-2021 were collected. Exclusion criteria included: inaccurate CPT code, ipsilateral compartment syndrome, bilateral fractures, incomplete medical records, or follow-up less than 10 months. Outcome Measures and Comparisons: In patients who underwent fixation of a tibial plateau fracture, compare Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF), PROMIS Preference (PROPr), and Knee Injury and Osteoarthritis Outcome Score (KOOS) between patients with a HEVTP pattern to those without. RESULTS: Two-hundred and seven patients were included, of which 17 (8%) had HEVTP fractures. Compared to non-HEVTP fracture patterns, patients with HEVTP injuries were younger (42.6 vs 51.0, p=0.025), more commonly male (71% vs 44%, p=0.033), and had higher body mass index (32.8 vs 28.0, p=0.05). HEVTP fractures had significantly more ligamentous knee (29% vs 6%, p=0.007) and vascular (12% vs 1%, p=0.035) injuries. PROMIS-PF scores were similar between groups, however, PROMIS-Preference (0.37 vs 0.51, p=0.017) was significantly lower in HEVTP fractures. KOOS pain, activities of daily living, and quality-of-life scores were statistically lower in HEVTP fractures, but only KOOS quality-of-life was clinically relevant (41.7 vs 59.3, p=0.004). CONCLUSION: The HEVTP fracture pattern, whether unicondylar or bicondylar, was associated with a higher rate of ligamentous and vascular injuries compared to non-HEVTP fracture patterns. They were also associated with worse health-related quality of life at mid-term follow-up.