Weigel, J Bone Joint Surg Am 2002 - High-Energy Fractures of the Tibial Plateau. Knee Function after Longer Follow-Up - Article Summary

High-Energy Fractures of the Tibial Plateau. Knee Function after Longer Follow-Up

Weigel, Marsh·J Bone Joint Surg Am·2002·242 citations·Retrospective cohort

Background

Studies of the long-term outcomes of treatment of fractures of the tibial plateau have included wide mixtures of fracture types and mostly low-energy split and split-depression fractures. The long-term results of treatment of high-energy intra-articular proximal tibial fractures are unknown. The purpose of this study was to assess the function of the knee and the development of arthrosis at a minimum of five years after injury in a consecutive series of patients in whom a high-energy fracture of the tibial plateau had been treated with a uniform technique of external fixation.

Methods

Between July 1988 and December 1994, 30 patients with a total of 31 fractures of the tibial plateau were treated with a monolateral external fixator and limited internal fixation of the articular surface.
Follow-up data on 24 knees in 23 patients were obtained at a mean of 98 months.
20 patients (20 knees) returned specifically for the study, at which time they completed an Iowa Knee Score questionnaire and a Short Form-36 (SF-36) general health survey, a physical examination was performed, and weight-bearing radiographs were made.
The results of the SF-36 evaluations for 14 patients and the Knee Scores for 12 were compared with those obtained 5 years previously, at 2 to 4 years after the injury.

Results

After healing, no patient required a secondary reconstructive procedure.
The range of motion of the knee averaged 3 degrees of extension to 120 degrees flexion, which was an average of 87% of the total arc of the contralateral knee.
The average Iowa Knee Score was 90 points (range, 72 to 100 points).
For 12 patients, the Iowa Knee Score previously recorded at 2 to 4 years averaged 92 points, as did the score at the time of the latest follow-up.
13 patients rated their outcome as excellent; 6, as good; and 3, as fair.
15 patients were working, and 10 of them were performing strenuous labor.
Radiographs showed no evidence of arthrosis in 14 knees, grade-1 arthrosis in 3, grade-2 in 3, and grade-3 in 2.
Compared with the radiographic appearance 2 to 4 years after injury, there was no evidence of progression of arthrosis in 18 knees and one grade of progression in 4.
The SF-36 subscale scores were similar to those of age-matched controls.
The 14 patients who had previous SF-36 scores had no deterioration of these scores.

Conclusions

Patients with a high-energy fracture of the tibial plateau treated with external fixation have a good prognosis for satisfactory knee function in the second five years after injury. The knee joint cartilage appears to be tolerant of both the injury and mild-to-moderate residual articular displacement, which was associated with a low rate of severe arthrosis.

Supplemental

High-Energy Fractures of the Tibial Plateau. Knee Function after Longer Follow-Up.

Weigel, MarshJ Bone Joint Surg Am2002242 citationsRetrospective cohort