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Neidlein C, Watrinet J, Pätzold R, Berthold DP, Prall WC, Böcker W, Holzapfel BM, Fürmetz J, Bormann M. Patient-Reported Outcomes following Tibial Plateau Fractures: Mid- to Short-Term Implications for Knee Function and Activity Level. J Clin Med 2024; 13:2327. [PMID: 38673600 PMCID: PMC11051425 DOI: 10.3390/jcm13082327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Patients with complex proximal tibial plateau fractures (TPFs) tend to overestimate the prognosis of their injury, potentially due to factors such as a limited understanding, optimism, and the influence of the pain intensity. Understanding the reasons behind this misperception is crucial for healthcare providers to effectively communicate with patients and establish realistic expectations for treatment outcomes. The purpose of this study was to analyze the outcomes of TPFs, with a particular focus on patient-reported outcome measures concerning functional recovery, pain levels, and overall satisfaction with treatment. The authors aim to provide valuable insights into the realistic expectations and potential limitations that patients may encounter during their recovery journey. Methods: In this retrospective single-center study, all surgically treated TPFs between January 2014 and December 2019 with a minimum follow-up of 12 months were included. Several patient-reported outcome measures were obtained, including the International Knee documentation Committee Score (IKDC), Lyholm score, Tegner score, and visual analog scale (VAS) for pain. Fractures were classified according to Schatzker, and then subgrouped into simple (Schatzker I-III) and complex (Schatzker IV-VI) fractures. Results: A total of 54 patients (mean age 51.1 ± 11.9 years, 59.3% female) with a mean follow-up time of 3.9 years were included. Schatzker II fractures were present in 48% (n = 26) of the cases, with Schatzker III in 6% (n = 3), Schatzker IV fractures in 6% (n = 3), and Schatker VI fractures in 41% (n = 22) of the cases. All outcome scores showed a significant improvement between the first year after surgery and the last follow-up (mean: 3.9 years). Simple fractures showed significantly lower patient-reported outcomes when compared to the preinjury state; however, good to excellent results were observed. Patient-reported outcomes of complex fractures showed no significant changes in the study period with good to excellent results. When it comes to the Lysholm score, there were no significant differences in the outcome between simple and complex fractures. Furthermore, there was a return-to-sports rate of 100%, with high rates of changing sporting activity in 25% (simple fractures) and 45% in complex fractures. Conclusions: The data from this study showed that both simple and complex tibial plateau fractures show favorable outcomes at the midterm follow-up, and that injury severity does not correlate with worse results. While patients may tend to overestimate the recovery speed, this research highlights the importance of long-term follow-up, demonstrating a substantial improvement between one year post-surgery and the final evaluation. Return-to-sports rates were high, with adjustments needed for certain activities. However, patients should recognize the need to shift to lower-impact sports and the lengthy recovery process.
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Affiliation(s)
- Claas Neidlein
- Department of Orthopedics and Trauma Surgery, University Hospital, LMU Munich, Musculoskeletal University Center Munich (MUM), Marchioninistraße 15, 81377 Munich, Germany; (C.N.)
| | - Julius Watrinet
- Department of Trauma Surgery, Trauma Center Murnau, Professor-Küntscher-Str. 8, 82418 Murnau, Germany
| | - Robert Pätzold
- Department of Trauma Surgery, Trauma Center Murnau, Professor-Küntscher-Str. 8, 82418 Murnau, Germany
| | - Daniel P. Berthold
- Department of Orthopedics and Trauma Surgery, University Hospital, LMU Munich, Musculoskeletal University Center Munich (MUM), Marchioninistraße 15, 81377 Munich, Germany; (C.N.)
| | - Wolf Christian Prall
- Devision of Knee, Hip, Shoulder and Elbow Surgery, Schoen Clinic Munich, Harlachinger Straße 51, 81547 Munich, Germany
| | - Wolfgang Böcker
- Department of Orthopedics and Trauma Surgery, University Hospital, LMU Munich, Musculoskeletal University Center Munich (MUM), Marchioninistraße 15, 81377 Munich, Germany; (C.N.)
| | - Boris Michael Holzapfel
- Department of Orthopedics and Trauma Surgery, University Hospital, LMU Munich, Musculoskeletal University Center Munich (MUM), Marchioninistraße 15, 81377 Munich, Germany; (C.N.)
| | - Julian Fürmetz
- Department of Orthopedics and Trauma Surgery, University Hospital, LMU Munich, Musculoskeletal University Center Munich (MUM), Marchioninistraße 15, 81377 Munich, Germany; (C.N.)
- Department of Trauma Surgery, Trauma Center Murnau, Professor-Küntscher-Str. 8, 82418 Murnau, Germany
| | - Markus Bormann
- Department of Orthopedics and Trauma Surgery, University Hospital, LMU Munich, Musculoskeletal University Center Munich (MUM), Marchioninistraße 15, 81377 Munich, Germany; (C.N.)
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O’Neill DC, Sato EH, Myhre LA, Kantor AH, Rothberg DL, Higgins TF, Marchand LS, Haller JM. Return to Skiing After Tibial Plateau Fracture. Orthop J Sports Med 2023; 11:23259671231205925. [PMID: 37868212 PMCID: PMC10585993 DOI: 10.1177/23259671231205925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 05/22/2023] [Indexed: 10/24/2023] Open
Abstract
Background Tibial plateau fractures in skiers are devastating injuries with increasing incidence. Few studies have evaluated patient-reported outcomes and return to skiing after operative fixation of a tibial plateau fracture. Purpose To (1) identify demographic factors, fracture characteristics, and patient-reported outcome measures that are associated with return to skiing and (2) characterize changes in skiing performance after operative fixation of a tibial plateau fracture. Study Design Case series; Level of evidence, 4. Methods We reviewed all operative tibial plateau fractures performed between 2016 and 2021 at a single level-1 trauma center. Patients with a minimum of 10-month follow-up data were included. Patients who self-identified as skiers or were injured skiing were divided into those who returned to skiing and those who did not postoperatively. Patients were contacted to complete the Patient-Reported Outcomes Measurement Information System-Physical Function domain (PROMIS-PF), the Knee injury and Osteoarthritis Outcome Score-Activities of Living (KOOS-ADL), and a custom return-to-skiing questionnaire. Multivariate logistic regression was performed with sex, injury while skiing, PROMIS-PF, and KOOS-ADL as covariates to evaluate factors predictive of return to skiing. Results A total of 90 skiers with a mean follow-up of 3.4 ± 1.5 years were included in the analysis. The rate of return to skiing was 45.6% (n = 41). The return cohort was significantly more likely to be men (66% vs 41%; P = .018) and injured while skiing (63% vs 39%; P = .020). In the return cohort, 51.2% returned to skiing 12 months postoperatively. The percentage of patients who self-reported skiing on expert terrain dropped by half from pre- to postinjury (61% vs 29.3%, respectively). Only 78% of return skiers had regained comfort with skiing at the final follow-up. Most patients (65%) felt the hardest aspect of returning to skiing was psychological. In the multivariate regression, the male sex and KOOS-ADL independently predicted return to skiing (P = .006 and P = .028, respectively). Conclusion Fewer than half of skiers who underwent operative fixation of a tibial plateau fracture could return to skiing at a mean 3-year follow-up. The knee-specific KOOS-ADL outperformed the global PROMIS-PF in predicting a return to skiing.
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Affiliation(s)
- Dillon C. O’Neill
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Eleanor H. Sato
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Luke A. Myhre
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Adam H. Kantor
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - David L. Rothberg
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Thomas F. Higgins
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Lucas S. Marchand
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Justin M. Haller
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, USA
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Rudran B, Little C, Wiik A, Logishetty K. Tibial Plateau Fracture: Anatomy, Diagnosis and Management. Br J Hosp Med (Lond) 2020; 81:1-9. [PMID: 33135915 DOI: 10.12968/hmed.2020.0339] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Tibial plateau fractures are peri-articular knee fractures of the proximal tibia. The presentation is dependent on the mechanism of injury. The tibial plateau is the bony platform of the distal half of the knee joint, and is made up of a medial and lateral condyle separated by the intercondylar eminence. The presentation of tibial plateau fractures can vary greatly as a result of the bimodal mechanism of injury and patient characteristics. The patient should be assessed for life- and limb-threatening injuries in accordance with British Orthopaedic Association Standards of Trauma guidelines. Imaging is undertaken to understand configuration of the fracture, which is classified by the Schatzker classification. Definitive management of the fracture depends on the severity, ranging from conservative to surgical management. Surgery is required for more severe tibial plateau fractures to restore articular congruity, mechanical alignment, ligamentous stability and to permit early mobilisation. Medium-term functional outcome after tibial plateau fractures is generally excellent when anatomy and stability is restored. At least half of patients return to their original level of physical activity. Surgical management of tibial plateau fractures is not without complication. Risk factors include postoperative arthritis, bicondylar and comminuted fractures, meniscal removal, instability, malalignment and articular incongruity. Tibial plateau fractures account for 1% of all fractures, and typically occur either as a fragility fracture or secondary to a high-energy impact. These latter injuries are associated with extensive soft tissue injury, life- and limb-threatening complications and long-term sequelae. While outcomes are generally good, severe injuries are at higher risk of infection and post-traumatic arthritis requiring knee arthroplasty. This article considers the anatomy, diagnosis and evidence-based management strategies for tibial plateau fracture.
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Affiliation(s)
| | - Christopher Little
- School of Medicine, Imperial College London, London, UK Conflicts of interest
| | - Anatole Wiik
- The MSk Lab, Imperial College London, London, UK
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Hap DXF, Kwek EBK. Functional outcomes after surgical treatment of tibial plateau fractures. J Clin Orthop Trauma 2020; 11:S11-S15. [PMID: 31992910 PMCID: PMC6977533 DOI: 10.1016/j.jcot.2019.04.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 04/14/2019] [Accepted: 04/15/2019] [Indexed: 11/25/2022] Open
Abstract
Tibial plateau fractures are significant because of its intra-articular nature. In this study, we aim to evaluate the functional outcomes of tibial plateau fractures after surgical treatment and to determine the rates of return to work and sports after recovery. This is a retrospective study conducted at a single tertiary-level institution. Forty-one patients with tibial plateau fractures were operatively treated during our study period. Patient information including injury mechanism, surgical treatment and associated injuries were documented. Pre-operative and post-operative radiographs were reviewed to confirm Schatzker type and adequacy of reduction. Follow up data for thirty-one patients was obtained nineteen to forty-two months post-surgery. All patients were administered functional outcome questionnaires using the Western Ontario and McMaster University Osteoarthritis index (WOMAC) and Short Form 36 (SF-36) general health survey. Data regarding return to work and sports was also collected. Data analysis was done to determine the relationship between fracture type, adequacy of reduction and functional outcome. The average WOMAC score for patients with Schatzker I to III was 6.3 out of a maximum score of 96, significantly lower than the Schatzker IV to VI group, whose average score was 18.4 (p = 0.0012). The SF-36 score for the Schatzker I to III group was also significantly higher than the VI to VI group (p = 0.0031). 71% of patients reported partial to full return to work, while 65% of patients did not return to sports after injury. In conclusion, the functional outcome of operatively treated tibial plateau fractures is satisfactory, with poorer functional outcome being associated with higher energy fractures. (Schatzker IV to VI) Majority of patients were able to return to their pre-injury employment but only a small minority were able to return to sports.
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Quintens L, Van den Berg J, Reul M, Van Lieshout E, Nijs S, Verhofstad M, Hoekstra H. Poor sporting abilities after tibial plateau fractures involving the posterior column: how can we do better? Eur J Trauma Emerg Surg 2019; 47:201-209. [PMID: 31473772 DOI: 10.1007/s00068-019-01220-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 08/26/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE Tibial plateau fractures with the involvement of the posterior column are an important prognostic factor towards poor functional outcome. We aimed to assess the sporting abilities postoperatively with special emphasis on the type of sports and sport-specific movements, as well as time needed to resume sports, restricting factors in sports engagement, and patient satisfaction. We aimed to provide prognostic information on return to sports. METHODS Demographic, clinical and radiological variables were retrospectively collected from 82 multicentric patients between 2014 and 2016. Prospectively, sporting abilities before and after surgery were determined using questionnaires at a mean follow-up of 33 months postoperatively. RESULTS Involvement in sports significantly decreased, with only 68.4% of patients resuming sports (p < 0.001). The mean time needed to partially or fully resume sports was 6-9 and 9-12 months, respectively. The ability to resume at the pre-injury level of effort and performance was 22% and 12%, respectively. Restricting factors were pain (66%), fear of re-injury (37%), limited range of motion (26%), and instability (21%). The majority (59%) of patients were unsatisfied with their physical abilities. Significantly worse outcomes were observed in patients playing high-impact sports, experiencing knee pain during physical activity, suffering from extension/valgus or flexion/varus trauma. CONCLUSIONS Tibial plateau fractures with the involvement of the posterior column significantly hamper the patients' sporting abilities, leaving the majority of patients unsatisfied. Preoperative counseling about prognosis, setting realistic expectations, optimizing rehabilitation and pain management postoperatively, and advising low-impact sports might improve engagement in physical activities and emotional impact on patients. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Liselore Quintens
- Department Trauma Surgery, University Hospital Leuven, KU Leuven, University of Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Juriaan Van den Berg
- Department Trauma Surgery, University Hospital Leuven, KU Leuven, University of Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Maike Reul
- Department of Orthopedics and Traumatology, VU Brussel, Free University of Brussels, Brussels, Belgium
| | - Esther Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Stefaan Nijs
- Department Trauma Surgery, University Hospital Leuven, KU Leuven, University of Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Michiel Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Harm Hoekstra
- Department Trauma Surgery, University Hospital Leuven, KU Leuven, University of Leuven, Herestraat 49, 3000, Leuven, Belgium.
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Lowe DT, Milone MT, Gonzalez LJ, Egol KA. Repair of Tibial Plateau Fracture (Schatzker II). JBJS Essent Surg Tech 2019; 9:e25. [PMID: 32021721 DOI: 10.2106/jbjs.st.18.00105] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Tibial plateau fracture is an injury commonly seen by those who treat trauma around the knee and/or sports-related injuries. In this video article, we present our protocol for surgical treatment of a tibial plateau fracture, which includes definitive fixation with use of a plate-and-screw construct, addressing of all associated soft-tissue injuries at the time of the surgical procedure, filling of any residual voids with bone cement, and early rehabilitation with weight-bearing beginning at 10 to 12 weeks postoperatively. The major steps of the procedure are (1) preoperative planning with digitally templated plates and screws, (2) patient positioning and setup, (3) anterolateral approach toward the proximal aspect of the tibia, (4) submeniscal arthrotomy, (5) booking open of the proximal aspect of the tibia at the fracture site, (6) tagging of the meniscus, (7) fracture reduction and placement of the Kirschner wire, (8) confirmation of reduction with C-arm image intensification, (9) internal fixation with a plate-and-screw construct, and (10) closure.
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Affiliation(s)
- Dylan T Lowe
- Department of Orthopedic Surgery (D.T.L., M.T.M) and Division of Trauma Surgery (K.A.E.), NYU Langone School of Medicine (L.J.G.), NYU Langone Orthopedic Hospital, New York, NY
| | - Michael T Milone
- Department of Orthopedic Surgery (D.T.L., M.T.M) and Division of Trauma Surgery (K.A.E.), NYU Langone School of Medicine (L.J.G.), NYU Langone Orthopedic Hospital, New York, NY
| | - Leah J Gonzalez
- Department of Orthopedic Surgery (D.T.L., M.T.M) and Division of Trauma Surgery (K.A.E.), NYU Langone School of Medicine (L.J.G.), NYU Langone Orthopedic Hospital, New York, NY
| | - Kenneth A Egol
- Department of Orthopedic Surgery (D.T.L., M.T.M) and Division of Trauma Surgery (K.A.E.), NYU Langone School of Medicine (L.J.G.), NYU Langone Orthopedic Hospital, New York, NY
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