THE PROXIMAL TIBIA JOINT FRACTURE AS AN INCREASING INJURY IN SKIING: EARLY RESULTS OF A PROSPECTIVE STUDY.

Abstract

Since the introduction of carving skis, the injuries of the tibia is changing from simple fractures of the diaphyse to complex fractures of the epiphyses, according to high energy traumas. There are no studies about results of the treatment and consequences after winter sport accidents.

Method: Prospective documentation of all proximal tibia fractures after winter sport accidents, which were treated between 01.12.2006 and 31.04.2009 in the Trauma Department of the Klinikum Garmisch-Parten-kirchen, Germany. X-Rays and CT scans were classified according to the AO –Classification. Operations, complications, co-injuries and the hospital stay were analysed. We performed the Lysholm score, WOMAC Knee-score and the Tegner-index on the day of injury, 6 months, 12 months, and 2 years after injury.

Results: 78 patients had a proximal tibia fracture following a skiing accident, 36 Male and 42 female. All except two patients had a monotrauma of the proximal tibia. Mean age 46 ± 15 years. 17 types A.1.3, 41 types B and 18 types C3 fractures. 4 patients developed a compartment syndrome, one patient had a lesion of the n. peroneus. 65 patients were operated in our hospital. In 8 patients we performed a conservative treatment. The mean hospital stay was 12 ± 7.5 days. In 15 patients a menisci reconstruction was necessary. 6 patients had a postoperative complication: 3 thromboses, 2 cardiac decompensations, 1 wound healing problems. By now 42 patients were ready for follow-up. So far the mean follow-up time is 13.8 months. The Lysholm score was at 12 months (n= 22) 78 ± 20 points. The Tegner score was pre-injury 6.2 ± 1.1 and 12 months post-injury 4.1 ± 1,8. The results of the WOMAC score show an improvement in the subcategories pain and function in all patients. In the subcategory stiffness only the type A and B fractures show an improvement during the follow-up.

Conclusion: The proximal tibia joint fractures are a serious injury. The most patients’ activity level is tremendously reduced. The major problem after one year seems to be the ligament instability of the knee. A beginning knee arthritis after one year becomes relevant only in the type C fractures. More effort for the prevention of the proximal tibia fractures while skiing is necessary.