Fri., 10/14/11 Knee, Foot & Ankle, Paper #59, 3:53 pm OTA-2011
Predictors of Knee Stiffness After Periarticular Fracture
Julius A. Bishop, MD1; Julie Agel, MA, ATC2; Robert P. Dunbar, Jr., MD2;
1Dept. of Orthopaedic Surgery, Stanford University School of Medicine,
Palo Alto, California, USA;
2Dept. of Orthopaedics and Sports Medicine, University of Washington,
Seattle, Washington, USA
Purpose: Knee stiffness after periarticular fracture is poorly understood in contrast to the relatively advanced understanding of stiffness after total knee arthroplasty or knee ligament injury. Knee stiffness has been reported as an important complication after fracture but a systematic evaluation of risk factors and outcomes has not yet been undertaken. Therefore, the aims of this study were to evaluate risk factors for knee stiffness requiring manipulation after periarticular fracture and to document the clinical outcomes.
Methods: This study was designed as a case control study in which patients requiring manipulation under anesthesia after periarticular fracture were compared to those who did not. Using billing data from a regional Level 1 trauma center, we identified 24 knees requiring manipulation for refractory stiffness over a 6-year period. These were matched based on AO/OTA classification with 43 control knees that did not develop stiffness requiring manipulation. Descriptive statistics were used for frequency and mean analysis.
Results: Univariate analysis revealed that extensor mechanism disruption (χ2 = 0.05), fasciotomy (χ2 = 0.020), the presence of wounds requiring ongoing management and precluding knee motion (P = 0.001), and the need for more than 3 surgical procedures to achieve definitive fracture fixation and soft-tissue coverage (P = 0.021) all put patients at increased risk for stiffness requiring manipulation. Time spent in a spanning external fixator was not a statistically significant predictor of stiffness (P = 0.16) but was clinically significant, with cases spending a mean of 21 days in a fixator compared to 8 days for controls. The average improvement in knee motion following all procedures targeting knee stiffness was 62°. Mean final flexion was significantly less in the case group at 107° as compared to the control group at 124° (P= 0.01).
Conclusions: This is the first study to systematically evaluate the risk factors for knee stiffness after periarticular fracture and document the outcomes of manipulation under anesthesia. It demonstrates that injury characteristics that delay or prevent postoperative knee motion put patients at increased risk for refractory knee stiffness. Although knee motion remains compromised, late surgery aimed at improving knee motion does lead to improvements in flexion.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.