OTA 1997 Posters - Tibia Fractures

Long Term Functional Outcome of Operatively Treated Tibial Plateau Fractures

Emil H. Schemitsch, MD, FRCS(C), David G. Stevens, MD, Rani Beharry, James P. Waddell, MD, FRCS(C)

St. Michael's Hospital, Univ. of Toronto, Toronto, Ontario, Canada

Purpose: To determine the long term functional outcome of operatively treated tibial plateau fractures.

Conclusion: Operatively treated tibial plateau fractures have satisfactory functional outcome at average 8 year follow-up. The most significant source of variation with respect to functional outcome was age at presentation.

Significance: Accurate reduction of displaced tibial plateau fractures results in satisfactory functional outcome regardless of fracture type. Patients under age 40 have similar health status to the normal age matched population.

Discussion: Forty-six patients from our trauma database with 47 operatively treated tibial plateau fractures and a minimum follow up of five years were reviewed. All aspects of their care including tibial plateau fracture type, operative management and associated injuries were documented. Pre-and postoperative follow up radiographs were analyzed for adequacy of reduction. All patients were then contacted and administered functional outcome questionnaires measuring both generic health status (SF-36 survey) and condition-specific outcome (WOMAC). Data regarding return to work and sporting activities was also collected. Assessment scores were analyzed with respect to age, fracture type and severity and also compared to standardized age and sex matched scores for the normal population.

The average age of the patients at the time of injury was 40 years (range 18-77) and the average follow up period was 8.3 years (range 5-25 years). There were 32 males and 14 females. Of the 47 fractures studied, 25 were classified as Schatzker types 1, 2 or 3 (OTA 41-B) and the remaining 22 were the more severe types 4, 5 or 6 (OTA 41-C). Three fractures were open (grades I, II and IIIB) and there was a large proportion of associated injuries involving knee ligaments and other local and systemic trauma. All fractures received operative treatment within 48 hours and all but 5 fractures were acceptably reduced.

Compared to the standardized SF-36 categorical and aggregate scores, there was no statistically significant difference between the normal age matched population and the majority of the under age 40 group regardless of fracture type. Specifically, 24 of 26 under age forty subjects scored as well as the standard controls. With regard to the over age 40 group, scores statistically similar to the control population were found in only 12 of 21 subjects (p<0.05). For the WOMAC scores, there was a trend to higher categorical and aggregate scores with increasing age at presentation. There was no correlation between WOMAC scores and fracture type. The most significant source of variation with respect to functional outcome was age at presentation and this had more significance than fracture type.