Juriaan van den Berg1, Maike Reul2, Menno Nunes Cardozo1, Anastasiya Starovoyt1, Eric Geusens3, Stefaan Nijs2,4, Harm Hoekstra5,6. 1. Faculty of Medicine, KU Leuven - University of Leuven, B-3000, Leuven, Belgium. 2. Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium. 3. Department of Radiology, University Hospitals Leuven, B-3000, Leuven, Belgium. 4. Department of Development and Regeneration, KU Leuven - University of Leuven, B-3000, Leuven, Belgium. 5. Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium. harm.hoekstra@uzleuven.be. 6. Department of Development and Regeneration, KU Leuven - University of Leuven, B-3000, Leuven, Belgium. harm.hoekstra@uzleuven.be.
Abstract
ABASTRACT: INTRODUCTION: Although regularly ignored, there is growing evidence that posterior tibial plateau fractures affect the functional outcome. The goal of this study was to assess the incidence of posterior column fractures and its impact on functional outcome and general health status. We aimed to identify all clinical variables that influence the outcome and improve insights in the treatment strategies. METHODS: A retrospective cohort study including 218 intra-articular tibial plateau fractures was conducted. All fractures were reclassified and applied treatment was assessed according to the updated three-column concept. Relevant demographic and clinical variables were studied. The patient reported outcome was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). RESULTS: Median follow-up was 45.5 (IQR 24.9-66.2) months. Significant outcome differences between operatively and non-operatively treated patients were found for all KOOS subscales. The incidence of posterior column fractures was 61.9%. Posterior column fractures, sagittal malalignment and an increased complication rate were associated with poor outcome. Patients treated according to the updated three-column concept, showed significantly better outcome scores than those patients who were not. We could not demonstrate the advantage of posterior column fracture fixation, due to a limited patient size. CONCLUSION: Our data indicates that implementation of the updated three-column classification concept may improve the surgical outcome of tibial plateau fractures. Failure to recognize posterior column fractures may lead to inappropriate utilization of treatment techniques. The current concept allows us to further substantiate the importance of reduction and fixation of posterior column fractures with restoration of the sagittal alignment. LEVEL OF EVIDENCE: 3.
ABASTRACT: INTRODUCTION: Although regularly ignored, there is growing evidence that posterior tibial plateau fractures affect the functional outcome. The goal of this study was to assess the incidence of posterior column fractures and its impact on functional outcome and general health status. We aimed to identify all clinical variables that influence the outcome and improve insights in the treatment strategies. METHODS: A retrospective cohort study including 218 intra-articular tibial plateau fractures was conducted. All fractures were reclassified and applied treatment was assessed according to the updated three-column concept. Relevant demographic and clinical variables were studied. The patient reported outcome was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). RESULTS: Median follow-up was 45.5 (IQR 24.9-66.2) months. Significant outcome differences between operatively and non-operatively treated patients were found for all KOOS subscales. The incidence of posterior column fractures was 61.9%. Posterior column fractures, sagittal malalignment and an increased complication rate were associated with poor outcome. Patients treated according to the updated three-column concept, showed significantly better outcome scores than those patients who were not. We could not demonstrate the advantage of posterior column fracture fixation, due to a limited patient size. CONCLUSION: Our data indicates that implementation of the updated three-column classification concept may improve the surgical outcome of tibial plateau fractures. Failure to recognize posterior column fractures may lead to inappropriate utilization of treatment techniques. The current concept allows us to further substantiate the importance of reduction and fixation of posterior column fractures with restoration of the sagittal alignment. LEVEL OF EVIDENCE: 3.
Authors: David P Barei; Sean E Nork; William J Mills; M Bradford Henley; Stephen K Benirschke Journal: J Orthop Trauma Date: 2004 Nov-Dec Impact factor: 2.512
Authors: David Wasserstein; Patrick Henry; J Michael Paterson; Hans J Kreder; Richard Jenkinson Journal: J Bone Joint Surg Am Date: 2014-01-15 Impact factor: 5.284