Influence of reduction quality on functional outcome and quality of life in the surgical treatment of tibial plateau fractures: A retrospective cohort study

Nils Beisemann; Sven Yves Vetter; Holger Keil; Benedict Swartman; Marc Schnetzke; Jochen Franke; Paul Alfred Grützner; Maxim Privalov

doi:10.1016/j.otsr.2021.102922

Influence of reduction quality on functional outcome and quality of life in the surgical treatment of tibial plateau fractures: A retrospective cohort study

Orthop Traumatol Surg Res. 2022 Nov;108(7):102922. doi: 10.1016/j.otsr.2021.102922. Epub 2021 Apr 6.

Authors

Nils Beisemann¹, Sven Yves Vetter¹, Holger Keil¹, Benedict Swartman¹, Marc Schnetzke¹, Jochen Franke¹, Paul Alfred Grützner¹, Maxim Privalov²

Affiliations

¹ Medical Imaging and Navigation in Trauma and Orthopaedic Surgery (MINTOS), BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany.
² Medical Imaging and Navigation in Trauma and Orthopaedic Surgery (MINTOS), BG Trauma Center Ludwigshafen, Heidelberg University Hospital, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany. Electronic address: maxim.privalov@bgu-ludwigshafen.de.

PMID: 33836282
DOI: 10.1016/j.otsr.2021.102922

Abstract

Background: Despite a substantial improvement in the operative treatment of tibial plateau fractures, the surgical procedure remains controversial and is generally challenging, as patients may develop postoperative arthritis and functional impairment of the knee joint.

Hypothesis: In the surgical treatment of tibial plateau fractures the intraoperative reposition quality has the greatest influence on the postoperative outcome, whereby misalignments of≥2mm lead to a worse result.

Patients and methods: Forty-one patients with tibial plateau fractures were postoperatively examined. The operative treatment was performed under reduction control using an intraoperative 3D C-arm. The follow-up collective was divided into two groups depending on the intraoperative reduction result. The postoperative results were then evaluated using the following parameters: Lysholm score, Rasmussen score, Tegner score, SF-36 score, range of motion and pain level.

Results: Group 1 (articular surface incongruencies<2mm) tended to achieve a better result in all scores than group 2 (articular surface incongruencies≥2mm), in the Lysholm score (p=0.039), in the comparison of the range of motion (p=0.012) and the pain level (p=0.039) this was significant. Group 1 achieved an average of 90.71 points (group 2: 78.74) in the Lysholm score. The average range of motion of the knee joint was 138.93° in group 1 (group 2: 127.78°). The average value of the current pain level in group 1 was 1.14 (group 2: 2.63).

Discussion: Both study groups achieved a very good result compared to the available literature. It appears that reduction quality - which can be analyzed with intraoperative 3D imaging - plays the most important role in postoperative quality of life and functional outcome. Intraoperative adjustments of the reduction should therefore be performed on joint surface irregularities with a size above 2mm.

Level of evidence: III; retrospective case control study.

Keywords: Intraoperative 3D imaging; Knee joint; Lower extremity; Reduction quality; Tibial plateau fracture.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Case-Control Studies
Fracture Fixation, Internal / methods
Humans
Pain / etiology
Quality of Life*
Retrospective Studies
Tibial Fractures* / diagnostic imaging
Tibial Fractures* / etiology
Tibial Fractures* / surgery
Treatment Outcome