Arthroscopic-Assisted Fixation of Tibial Plateau Fractures: Patient-Reported Postoperative Activity Levels

Abstract Background Surgical site infection (SSI) occurs in 3–10 % of patients with surgically treated tibial plateau fractures. This study aimed to evaluate the impact of SSI on patients’ outcome after fixation of tibial plateau fractures. Methods We conducted a retrospective multicenter study in seven participating level I trauma centers between January 2005 and December 2014. All participating centers followed up with patients with SSI. In addition, three centers followed up with patients without SSI as a reference group. Descriptive data and follow-up data with patient-reported outcome scores (Knee Injury and Osteoarthritis Outcome Score [KOOS] and Lysholm knee scoring scale score) were evaluated. Results In summary, 287 patients (41 with SSI and 246 without SSI; average 50.7 years) with an average follow-up of 75.9 ± 35.9 months were included in this study. Patients with SSI had a significantly poorer overall KOOS (KOOS5) (48.7 ± 23.2 versus [vs.] 71.5 ± 23.5; p < 0.001) and Lysholm knee scoring scale score (51.4 ± 24.0 vs. 71.4 ± 23.5; p < 0.001) than patients without SSI. This significant difference was also evident in the KOOS subscores for pain, symptoms, activities of daily living (ADL), and quality of life (QoL). SSI remained an important factor in multivariable models after adjusting for potential confounders. Clinically relevant differences in the KOOS5 and KOOS subscores for symptoms, pain, and ADL were found between those with SSI and without SSI even after adjustment. Furthermore, the number of previous diseases, Arbeitsgemeinschaft für Osteosynthesefragen Foundation (AO) C fractures, and compartment syndrome were found to be additional factors related to poor outcome. Conclusions Compared to previous studies, validated patient-reported outcome scores demonstrated that the impact of SSI in patients with surgically treated tibial plateau fractures is dramatic, in terms of not only pain and symptoms but also in ADL and QoL, compared to that in patients without SSI.

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

The Bone & Joint Journal ◽

10.1302/0301-620x.102b5.bjj-2019-1385.r1 ◽

2020 ◽

Vol 102-B (5) ◽

pp. 632-637 ◽

Cited By ~ 2

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.

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Trauma mechanism and patient reported outcome in tibial plateau fractures with posterior involvement

The Knee ◽

10.1016/j.knee.2021.03.011 ◽

2021 ◽

Vol 30 ◽

pp. 41-50

Author(s):

J. Van den Berg ◽

A.S. De Boer ◽

N. Assink ◽

R. Haveman ◽

M. Reul ◽

...

Keyword(s):

Tibial Plateau ◽

Patient Reported Outcome ◽

Tibial Plateau Fractures ◽

Trauma Mechanism ◽

Patient Reported

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Impact of anti-gravity treadmill rehabilitation therapy on the clinical outcomes after fixation of lower limb fractures: A randomized clinical trial

Clinical Rehabilitation ◽

10.1177/0269215520966857 ◽

2020 ◽

pp. 026921552096685

Author(s):

Ralf Henkelmann ◽

Lisa Palke ◽

Sebastian Schneider ◽

Daniel Müller ◽

Bernhard Karich ◽

...

Keyword(s):

Knee Injury ◽

Tibial Plateau ◽

Tibial Plateau Fractures ◽

Ankle Fractures ◽

Thigh Muscle ◽

Foot And Ankle ◽

Outcome Score ◽

Significant Difference ◽

Patient Reported ◽

Partial Weight

Objective: To compare the effects of anti-gravity treadmill rehabilitation with those of standard rehabilitation on surgically treated ankle and tibial plateau fractures. Design: Open-label prospective randomized multicenter study. Setting: Three level 1 trauma centers. Subjects: Patients with tibial plateau or ankle fractures who underwent postoperative partial weight-bearing were randomized into the intervention (anti-gravity treadmill use) or control (standard rehabilitation protocol) groups. Main measures: The primary endpoint was the change in the Foot and Ankle Outcome Score for ankle fractures and total Knee injury and Osteoarthritis Outcome Score for tibial plateau fractures (0–100 points) from baseline (T1) to six weeks after operation (T4) in both groups. Leg circumference of both legs was measured to assess thigh muscle atrophy in the operated leg. Results: Thirty-seven patients constituted the intervention and 36 the control group, respectively; 14 patients dropped out during the follow-up period. Among the 59 remaining patients (mean age 42 [range, 19–65] years), no difference was noted in the Foot and Ankle Outcome Score (54.2 ± 16.1 vs. 56.0 ± 16.6) or Knee injury and Osteoarthritis Outcome Score (52.8 ± 18.3 vs 47.6 ± 17.7) between the intervention and control groups 6 weeks after operation. The change in the leg circumference from T1 to T4 was greater by 4.6 cm in the intervention group (95% confidence interval: 1.2–8.0, P = 0.005). No adverse event associated with anti-gravity treadmill rehabilitation was observed. Conclusion: No significant difference was noted in patient-reported outcomes between the two groups. Significant differences in muscular atrophy of the thigh were observed six weeks after operation.

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

10.21203/rs.3.rs-154378/v1 ◽

2021 ◽

Author(s):

Ralf Henkelmann ◽

Karl-Heinz Frosch ◽

Richard Glaab ◽

Meinhard Mende ◽

Christopher Ull ◽

...

Keyword(s):

Surgical Site Infection ◽

Multicenter Study ◽

Tibial Plateau ◽

Tibial Plateau Fractures ◽

Site Infection ◽

Significant Difference ◽

Patient Reported ◽

The Impact ◽

Retrospective Multicenter Study

Abstract Background: Tibial plateau fractures (TPF) can be a life changing injury. Surgical site infection (SSI) occur in 3-10% and is a feared complication. Aim of this study was to evalute the impact of SSI to outcome in patients with operatively treated TPF.Methods: We conducted a retrospective multicenter study in seven participating countries. Between January 2005 and December 2014 all participating centers have followed up patients with SSI. In addition, three centers followed up patients without SSI as a reference group. Descriptive data and follow up data with patient reported outcome scores (KOOS, Lysholm) were evaluated. Statistic analyses were performed with IBM SPSS and two-sided tests to the significance level of α = 0.05. Results: In summary, 287 patients (41 with SSI and 246 without SSI) with an average follow-up of 75.9 ± 35.9 months were included in this study. Patients with a SSI had a significant poorer Outcome in KOOS5 (48.7 ± 23.2 vs. 71.5 ± 23.5; p < 0.001) and Lysholm (51.4 ± 24.0 vs. 71.4 ± 23.5; p < 0.001) compared to patients without SSI. This significant difference was also evident in the KOOS subscores pain (57.9 ± 22,9 vs. 75.0 ± 22.3; p < 0.001), symptoms (54.5 ± 28.8 vs. 75.4 ± 23.4; p < 0.001), ADL (48.8 ± 27.5 vs. 80.5 ± 22.6; p < 0.001) and QOL (37.8 ± 31.5 vs. 56.4 ± 30.2; p = 0.001).Conclusion: Patients with SSI differed significantly from patients without SSI in terms of gender, smoking and drug addiction. The trauma-associated data showed a significant difference in the severity of fracture morphology, concomitant injuries (especially open fracture and compartment syndrome), and the incidence of polytraumata. In terms of PRO, a significantly poorer outcome was recorded in patients with SSI.

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A New Approach to Surgical Management of Tibial Plateau Fractures

Journal of Clinical Medicine ◽

10.3390/jcm9030626 ◽

2020 ◽

Vol 9 (3) ◽

pp. 626 ◽

Cited By ~ 2

Author(s):

Stuart A. Callary ◽

Claire F. Jones ◽

Karim Kantar ◽

Heleen Du Toit ◽

Markus P. Baker ◽

...

Keyword(s):

Tibial Plateau ◽

Weight Bearing ◽

Surgical Site Infections ◽

Tibial Plateau Fractures ◽

Fracture Reduction ◽

Management Approach ◽

Anterolateral Approach ◽

Complication Rates ◽

Management Protocol ◽

Patient Reported

Tibial plateau fractures (TPFs) are challenging, requiring complex open reduction and internal fixation (ORIF) and are often associated with complications including surgical site infections (SSIs). In 2007, we introduced a novel management protocol to treat TPFs which consisted of an angiosome- or perforator-sparing (APS) anterolateral approach followed by unrestricted weight bearing and range of motion. The primary aim of this retrospective study was to investigate complication rates and patient outcomes associated with our new management protocol. In total, 79 TPFs treated between 2004 and 2007 through a classic anterolateral surgical approach formed the “Classic Group”; while 66 TPFS treated between 2007 and 2013 formed the “APS Group”. Fracture reduction, maintenance of reduction and patient-reported outcomes were assessed. There was a clinically important improvement in the infection incidence with the APS (1.5%) versus the Classic technique (7.6%) (1/66 versus 2/79 for superficial infections; 0/66 versus 4/79 for deep infections). Despite a more aggressive rehabilitation, there was no difference in the fracture reduction over time or the functional outcomes between both groups (p > 0.05). The APS anterolateral approach improved the rate of SSIs after TPFs without compromising fracture reduction and stabilisation. We continue to use this new management approach and early unrestricted weight bearing when treating amenable TPFs.

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