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

The 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.

Systematic Team-Approach Rehabilitation After Knee Fracture Surgery Is Associated With Better Functional Outcomes

Purpose In Western developed countries, patients commonly receive rehabilitation after orthopedic surgery to improve functional dysfunction. In China, however, rehabilitation is widely neglected. An appropriate perioperative rehabilitation model for early orthopedic rehabilitation is urgently needed in China. We evaluated the outcomes of perioperative rehabilitation patterns and promoted the functional recovery of orthopedic patients in China. Methods 668 patients from 9 centers who underwent internal fixation surgery because of knee joint fracture were assigned to 2 groups: 1) control group: received the standard postoperative treatments, or 2) trial group: received perioperative rehabilitation in team-based approach. The visual analog scale (VAS), Hospital for Special Surgery (HSS) knee and Berg Balance Scale (BBS) scores were assessed 12 and 24 weeks postoperatively. Results The VAS scores at 12 and 24 weeks postoperative showed that the trial group had significantly less pain than control group (P < 0.001). Compared to the control group, the trial group had significantly better HSS knee scores at 12 weeks (P < 0.05) and significantly better BBS scores at both 12 and 24 weeks postoperative (P < 0.05). Conclusions Compared to common postoperative treatments, patients with systematic team-approach rehabilitation had better functional outcomes and pain relief after knee fracture surgery.