Abstract
Purpose: To determine the incidence of OA and long-term outcome following complex, Schatzker type 4,5 & 6, tibial plateau fractures.
Patients and Methods: From Jan 1993 to Dec 2000, 176 consecutive adult patients with tibial plateau fractures were treated in our institution. Among them there were 31 patients (20 male and 11 female) with Schatzker type 4,5 & 6 fractures (17.5%). Details such as the patients’ age, sex, ISS, type of fracture, whether the fracture was open or closed, method of fixation, incidence of delayed union, non-union, the time to union, necessity for additional procedures, complications and hospital stay were recorded and analyzed. Following discharge from the hospital all the patients were followed up in the outpatient fracture clinic having regular clinical and radiological assessment. At final follow up all the patients were recalled in the clinic for clinical assessment. Functional assessment of the patients was performed using the American Knee score. Particular emphasis was to find out the impact of these complex injuries on their employment, their quality of life and the incidence of OA. The mean follow up was 16.8 months (ranges from 6–48 months). The mean time in hospital was 3.5 weeks (range 1–12 weeks).
Results: The mean age of the patients was 52 years (range from 25–76 years) and the mean ISS was 18 (6–44). 8 patients had associated injuries (1 had head injury). 24 patients sustained injury secondary to RTA, 6 secondary to fall and 1 secondary to a gun shot injury. 26 fractures were closed and 5 were open (1 Gustilo grade1, 1 grade IIIa and 3 grade IIIb). 29 patients were treated operatively and 2 were managed conservatively. 12 fractures were stabilized initially with AO hybrid frame and cannulated screws, 15 cases were treated with internal fixation (buttress plate), 1 case was treated with double plating and one case was treated with combination of internal fixation and Hoffman external fixator. Intra-operatively a bone graft from iliac crest was used in 7 patients. Soft tissue coverage was required in 4 cases. There were 2 cases of compartment syndrome, 9 cases of superficial infection and 5 cases of deep infection. Overall 10 patients were subjected to a secondary operative procedure following union (5 patients had removal of metal work, one underwent removal of metal work and application of a hemicallotasis device and 4 patients underwent arthroscopy). 7 patients underwent a 3rd procedure (3 had removal of metal work, one had application of a hemicallotasis device, 2 underwent debridement and curettage of the discharging sinus and one patient required a total knee replacement).
There were 6 cases of residual varus deformity (2 with 15 and 4 with 20 degrees) and 3 cases of leg length discrepancy (2.5 cm, 2 and 1.5 cm respectively). All the fractures but 2 progressed to union (one is currently awaiting for a total knee replacement). Functional assessment according to American Knee assessment score was good in 25 cases (80.64%), fair in 4 cases (12.87%) and poor in 2 cases (6.49%). The overall functional score was 93.6%. 9 patients had to do some modifications in their current employment and 7 patients were unable to return to their previous employment. Evidence of radiological OA was present in 18 out of 31 cases (58.6%).
A poor correlation between presence of radiological OA and functional outcome was noted.
Conclusion: 29 (93.5%) patients had a good or fair outcome. Tibial plateau fractures continue to be a cause of morbidity in trauma patients. The incidence of OA in this series of patients was 58.6% but there was no correlation to functional outcome.
The abstracts were prepared by Eleni Koutsoukou. Correspondence should be addressed to him at the Hellenic Association of Orthopaedic Surgery and Traumatology (HAOST), 20, A. Fleming str, 15123 Marousi, Athens, Greece.
