A Comparative Study of Clinical Outcomes and Functional Status after Knee Fracture and Knee Fracture Dislocation

2021 ◽  
Author(s):  
Mackenzie L Bird ◽  
Kristofer E Chenard ◽  
Leah J Gonzalez ◽  
Sanjit R Konda ◽  
Philipp Leucht ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Clinical Outcomes ◽  
Functional Outcomes ◽  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Arterial Injury ◽  
Tibial Plateau Fractures ◽  
Knee Fracture ◽  
Plateau Fracture

AbstractThe aim of this study was to compare outcomes of tibial plateau fracture dislocations (FD) with tibial plateau fractures alone. This study was an analysis of a series of tibial plateau fractures, in which FD was defined as a fracture of the tibial plateau with an associated loss of congruent joint reduction and stability of the knee, and classified by the Moore system. Patient data collected included demographics, injury information, and functional outcomes (short musculoskeletal function assessment [SMFA] score and Pain by the visual analog scale). Clinical outcomes at follow-up were recorded including knee range of motion, knee stability and development of complications. There were a total of 325 tibial plateau fracture patients treated operatively, of which 22.2% were identified as FD (n = 72). At injury presentation there was no difference with regard to nerve injury or compartment syndrome (both p > 0.05). FD patients had a higher incidence of arterial injury and acute ligament repair (both p < 0.005). At a mean follow-up of 17.5 months, FD patients were similar with regard to pain, total SMFA scores, and return to sports than their non-FD counterparts (p = 0.884, p = 0.531, p = 0.802). FD patients were found to have decreased knee flexion compared with non-FD patients by 5 degrees (mean: 120 and 125 degrees) (p < 0.05). FD patients also had a higher incidence of late knee instability and subsequent surgery for ligament reconstruction (p < 0.005 & p < 0.05). However, there was no difference in neurological function between groups at follow-up (p = 0.102). Despite the higher incidence of ligamentous instability and decreased range of motion, FD patients appear to have similar long-term functional outcomes compared with non-FD of the tibial plateau. While FD patients initially presented with a higher incidence of arterial injury, neurovascular outcomes at final follow-up were similar to those without a dislocation.

scholarly journals Three-column Subdivision for Isolated Posterolateral Tibial Plateau Fractures and Perspective Surgical Approachs

2020 ◽  
Author(s):  
Jae Ang Sim ◽  
Ji Hyeon Park ◽  
Young Gon Na ◽  
Byung Hoon Lee
Keyword(s):  
Range Of Motion ◽  
Clinical Outcomes ◽  
Surgical Approach ◽  
Postoperative Period ◽  
Supine Position ◽  
Tibial Plateau ◽  
Tibial Plateau Fractures ◽  
Anterolateral Approach ◽  
Plateau Fracture

Abstract Background: Management of the tibial plateau fracture involving posterolateral compartment is technically challenging. This study aimed to introduce a computed tomography-based classification of the posterolateral compartment of tibial plateaus based on the fibula and to propose the individualized surgical approaches for each zone; and 2) to determine the surgical approach based on the classification, would achieve a safe and effective reduction and can improve postoperative clinical outcomes.Methods: Eighteen cases of tibia plateau fracture involved the isolated posterolateral compartment in a single institution were retrospectively analyzed. The posterolateral compartment of tibial plateau was segmented into three zones based on the fibular position and individualized surgical approach was proposed for each zone. In anterior Zone I, surgical treatment was performed using an extended anterolateral approach and patient was placed in the supine position; In middle Zone II, using the transfibular approach in the supine position; In posterior Zone III, using the posteromedial approach in prone. Articular reduction (intra-articular step off in CT images) and mechanical medial proximal tibial angle (mMPTA) in simple radiographs taken in the immediate postoperative period and clinical outcomes of the Lysholm knee scoring scale and range of motion were evaluated at postoperative 1-year follow-up,Results: In all cases, anatomical articular reduction (intra-articular step off < 2mm) was achieved, maintained for the follow-up period. The average mMPTA was increased from 87.6º before surgery to 88.2º in immediate postoperative period (p = 0.060), and maintained for the follow-up period (mean 89.9º at one-year follow-up). At the 1-year follow-up, the knee range of motion averaged 140 degrees and the Lysholm knee function scored 95.0 points.Conclusion: An individualized surgical approach and fixation according to three-zone subdivision for isolated posterolateral tibial plateau fractures provided an effective and safe method to treat posterolateral tibial plateau fractures. Level of evidence: Therapeutic study, IV

scholarly journals Comparison of Functional Outcomes of Tibial Plateau Fractures Treated with Nonlocking and Locking Plate Fixations: A Nonrandomized Clinical Trial

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Mohammad Ali Tahririan ◽  
Seyyed Hamid Mousavitadi ◽  
Mohsen Derakhshan
Keyword(s):  
Functional Outcomes ◽  
Tibial Plateau ◽  
Locking Plate ◽  
Plate Fixation ◽  
Tibial Plateau Fractures ◽  
Plate Method ◽  
Plate Group ◽  
Plateau Fracture ◽  
The Mean

Fixation of tibial plateau fractures with plate has been widely used. This prospective study was planned to compare locking plate fixation of tibial plateau fracture with nonlocking methods in terms of their functional outcomes. The subjects of the study were selected from consecutive patients suffering from tibial plateau fractures referred to Kashani Hospital in Isfahan, Iran, between 2012 and 2013 and were candidate for surgery. The final included patients were assigned to two groups, those who were treated with locking plate (n=20) and those who were treated with nonlocking plates (N=21). The mean duration of follow-up was 13.4 months (ranging between 10 and 17 months). The mean of knee scores was significantly higher in locking plate group than in nonlocking plate group at the follow-up time (80.20±10.21 versus 72.52±14.75, P=0.039). Also, the mean VAS pain severity score was significantly lower in locking plate group compared with nonlocking plate group (4.45±2.50 versus 6.00±2.59, P=0.046). This study confirmed superiority of the locking plate method over nonlocking plate method with regard to knee score as well as VAS pain score.

scholarly journals Participation in Recreational Athletics After Operative Fixation of Tibial Plateau Fractures: Predictors and Functional Outcomes of Those Getting Back in the Game

2017 ◽  
Vol 5 (12) ◽  
pp. 232596711774391 ◽  
Author(s):  
David N. Kugelman ◽  
Abdullah M. Qatu ◽  
Jack M. Haglin ◽  
Sanjit R. Konda ◽  
Kenneth A. Egol
Keyword(s):  
Postoperative Complications ◽  
Alcohol Consumption ◽  
Range Of Motion ◽  
Functional Outcomes ◽  
Tibial Plateau ◽  
Tibial Plateau Fractures ◽  
Severe Injuries ◽  
White Race ◽  
Operative Fixation

Background: Tibial plateau fractures can be devastating traumatic injuries to the knee, particularly in active athletes. Purpose/Hypothesis: The purpose of this study was to report on the return to participation in recreational athletics after operatively managed tibial plateau fractures. In addition, this study assessed factors associated with the ability to return to participation in recreational athletics after tibial plateau fractures treated with open reduction internal fixation and compared final outcomes between patients who were able to return to recreational athletics and those who could not. The hypothesis was that returning to participation in recreational athletics would be dependent on the time from surgery after operative fixation of tibial plateau fractures. Less severe injuries would be associated with a quicker return to athletics. Study Design: Case-control study; Level of evidence, 3. Methods: All tibial plateau fractures treated by 1 of 3 surgeons at a single academic institution over an 11-year period were prospectively followed. Final outcomes were evaluated using the Short Musculoskeletal Function Assessment at latest follow-up. All complications were recorded at each follow-up. Differences between the groups were compared using Student t tests for continuous variables. Chi-square analysis was used to determine whether differences between categorical variables existed. Logistic regression was performed to assess independent variables associated with returning to participation in recreational athletics. Results: A total of 169 patients who underwent operative management of their tibial plateau fracture reported participation in recreational athletics before their injury. By the 6-month time point, 48 patients (31.6%) had returned to participation in recreational athletics, and at final follow-up (mean, 15 months), 89 patients (52.4%) had returned to participation in recreational athletics. Predictors of returning to recreational athletics included white race, female sex, social alcohol consumption, younger age, increased range of motion (ROM), low-energy Schatzker patterns (I-III), injuries not inclusive of orthopaedic polytrauma or open fractures, and no postoperative complications. White race, social alcohol consumption, and increased ROM were associated with returning to athletics at both 6-month and final follow-up. Lack of a venous thromboembolism was associated with returning to athletics at final follow-up. Patients who returned to recreational athletics had associations with better functional outcomes and emotional status than those who did not. Conclusion: The number of patients who returned to participation in recreational athletics gradually increased over time after operative fixation of tibial plateau fractures. Less severe injuries and a lack of postoperative complications were associated with a quicker return to athletics. Predictors of returning to participation in recreational athletics after operatively managed tibial plateau fractures can be used to target patients at risk of not returning to play to provide interventions aimed at improving their recovery, such as early knee range of motion, muscle strengthening, and participation in low-impact activities.

scholarly journals Three-column Subdivision for Isolated Posterolateral Tibial Plateau Fractures and Perspective Surgical Approachs

2021 ◽  
Author(s):  
Jae Ang Sim ◽  
Ji Hyeon Park ◽  
Young Gon Na ◽  
Byung Hoon Lee
Keyword(s):  
Range Of Motion ◽  
Surgical Approach ◽  
Postoperative Period ◽  
Supine Position ◽  
Tibial Plateau ◽  
Tibial Plateau Fractures ◽  
Surgical Approaches ◽  
Anterolateral Approach ◽  
Plateau Fracture

Abstract BackgroundManagement of the tibial plateau fracture involving posterolateral compartment is technically challenging. This study aimed to introduce a computed tomography-based classification of the posterolateral compartment of tibial plateaus based on the fibula and to propose the individualized surgical approaches for each zone; and 2) to determine the surgical approach based on the classification, would achieve a safe and effective reduction and can improve postoperative clinical outcomes.MethodsEighteen cases of tibia plateau fracture involved the isolated posterolateral compartment in a single institution were retrospectively analyzed. The posterolateral compartment of tibial plateau was segmented into three zones based on the fibular position and individualized surgical approach was proposed for each zone. In anterior Zone I, surgical treatment was performed using an extended anterolateral approach and patient was placed in the supine position; In middle Zone II, using the transfibular approach in the supine position; In posterior Zone III, using the posteromedial approach in prone. Articular reduction (intra-articular step off in CT images) and mechanical medial proximal tibial angle (mMPTA) in simple radiographs taken in the immediate postoperative period and clinical outcomes of the Lysholm knee scoring scale and range of motion were evaluated at postoperative 1-year follow-up,ResultsIn all cases, anatomical articular reduction (intra-articular step off < 2 mm) was achieved, maintained for the follow-up period. The average mMPTA was increased from 87.6º before surgery to 88.2º in immediate postoperative period (p = 0.060), and maintained for the follow-up period (mean 89.9º at one-year follow-up). At the 1-year follow-up, the knee range of motion averaged 140 degrees and the Lysholm knee function scored 95.0 points.ConclusionAn individualized surgical approach and fixation according to three-zone subdivision for isolated posterolateral tibial plateau fractures provided an effective and safe method to treat posterolateral tibial plateau fractures.Level of evidence: Therapeutic study, IV

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

2020 ◽  
Vol 102-B (5) ◽  
pp. 632-637 ◽  
Author(s):  
L. J. Gonzalez ◽  
K. Hildebrandt ◽  
K. Carlock ◽  
S. R. Konda ◽  
K. A. Egol
Keyword(s):  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Tibial Plateau Fractures ◽  
Term Outcome ◽  
Patient Reported ◽  
Schatzker Classification ◽  
Plateau Fracture ◽  
One Year

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.

A Novel Method of the Treatment for Posterolateral Tibial Plateau Fractures

2019 ◽  
Vol 33 (10) ◽  
pp. 1010-1019
Author(s):  
Dong Ren ◽  
Yueju Liu ◽  
Yanxi Chen ◽  
Jian Lu ◽  
Zhaohui Song ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Vertical Displacement ◽  
Knee Extension ◽  
Tibial Plateau Fractures ◽  
Posterolateral Approach ◽  
Anterolateral Approach ◽  
Plateau Fracture

AbstractReduction and fixation of posterolateral tibial plateau fracture via a posterolateral approach is challenging, and the posterolateral approach itself may injure the posterolateral ligament complex of the knee and can result in knee instability. We developed a new curved support plate (CSP) that can pass, via traditional anterolateral approach, through the superior tibiofibular interval and effectively support the posterolateral fragments. The purpose of our study was to determine the biomechanical reliability of the new plate and report the preliminary efficacy of the CSP for posterolateral tibial plateau fracture. In the biomechanical experiment, 40 synthetic tibias were used to create posterolateral shearing tibial fracture models, which were randomly assigned to groups A to D. Vertical displacement of the posterolateral fragments was measured under axial loads of 500 to 1,500 N. The new plate and 3.5-mm lateral locking plate exhibited similar control over fragment displacement. From June 2016 to August 2017, eight patients with posterolateral tibial plateau fracture underwent treatment with the CSP. Hospital for Special Surgery (HSS) knee score, knee flexion and extension ranges of motion, and complications were recorded to evaluate treatment effects. Eight patients (five men and three women, mean age 44 years [range, 23–66 years]) were enrolled in the study. Mean follow-up time was 13 months (range, 7–19 months). All patients achieved radiographic bone union by 3.3 months (range, 3–4 months) postoperatively. There were no complications of neurovascular injury, deep vein thrombosis, infection, and implant loosening throughout the follow-up period. At final follow-up, mean HSS score was 92.6 (88–96), with a mean knee flexion of 131.25 degrees (120–135 degrees) and a mean knee extension of 1 degree (0–5 degrees). Fixation of posterolateral tibial plateau fracture was easily and successfully achieved using our newly designed CSP, which may provide a new choice for posterolateral tibial plateau fractures.

Age-Related Variances in Patients with Tibial Plateau Fractures

2019 ◽  
Vol 33 (06) ◽  
pp. 611-615 ◽  
Author(s):  
Lasun O. Oladeji ◽  
John R. Worley ◽  
Brett D. Crist
Keyword(s):  
Elderly Patients ◽  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
The Elderly ◽  
Tibial Plateau Fractures ◽  
Mechanism Of Injury ◽  
Younger Patients ◽  
Age Related ◽  
Comorbidity Burden ◽  
Plateau Fracture

AbstractTibial plateau fractures account for approximately 8% of fractures in the elderly population. Treatment strategies in the elderly are similar to those for younger patients; however, practitioners must account for the elevated comorbidity burden in this population. To date, few studies have analyzed age-based outcomes in patients with tibial plateau fractures. Therefore, the purpose of this study was to determine age-related variances in demographics, fracture characteristics, mechanism of injury, and complications. A 10-year retrospective review was conducted to identify patients who received treatment for a tibial plateau fracture. There were 351 patients (360 tibial plateau fractures) who were identified and subsequently stratified according to their age at the time of injury. Patients were classified as elderly if they were 65 years of age or older at the time of injury; all other patients were included in the control cohort. These two cohorts were analyzed using bivariate analysis to isolate for age-related variations with respect to risk factors, mechanism of injury, and complications. There were 351 patients (360 tibial plateau fractures) with a median follow-up of 1.84 ± 2.44 years who met inclusion criteria. There were a greater proportion of women in the elderly cohort as compared with the younger cohort (60.0 vs. 43.4%, p = 0.06). Elderly patients were significantly more likely to present with diabetes (33.3 vs. 16.1%, p = 0.01) or osteoporosis (14.3 vs. 1.6%, p = 0.001). Younger patients were significantly more likely to require further surgery to address ligament (12.6 vs. 0%, p = 0.008), meniscus (20.9 vs. 7.1%, p = 0.036), or cartilage pathology (13.6 vs. 0%, p = 0.005). There was no difference in the arthroplasty conversion rate (4.8% elderly vs. 7.9% control, p = 0.755). While elderly patients presented with a greater comorbidity burden, they had equivalent or better short-term outcomes when compared with their younger peers when treated with open reduction and internal fixation (ORIF). Despite the recent interest in primary total knee arthroplasty for elderly patients with tibial plateau fractures, the results of this study suggest that elderly patients may respond well when treated with ORIF following a tibial plateau fracture.

Mapping recovery in simple and complex tibial plateau fracture fixation

2019 ◽  
Vol 101-B (8) ◽  
pp. 1009-1014 ◽  
Author(s):  
D. N. Ramoutar ◽  
K. Lefaivre ◽  
H. Broekhuyse ◽  
P. Guy ◽  
P. O’Brien
Keyword(s):  
Functional Outcome ◽  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Short Form ◽  
Tibial Plateau Fractures ◽  
Functional Score ◽  
Complex Group ◽  
Sf 36 ◽  
Functional Scores ◽  
Plateau Fracture

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.

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