Nick Assink1,2, Joep Kraeima3, Anne M L Meesters4,3, Mostafa El Moumni4, Eelke Bosma5, Robert J Nijveldt6, Sven H van Helden6, Jean-Paul P M de Vries7, Max J H Witjes3, Frank F A IJpma4. 1. Department of Trauma Surgery, University of Groningen, University Medical Center HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands. n.assink@umcg.nl. 2. 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. n.assink@umcg.nl. 3. 3D Lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. 4. Department of Trauma Surgery, University of Groningen, University Medical Center HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands. 5. Department of Trauma Surgery, Martini Hospital, Groningen, The Netherlands. 6. Department of Trauma Surgery, Isala Hospital, Zwolle, The Netherlands. 7. Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.
Abstract
PURPOSE: Currently used classification systems and measurement methods are insufficient to assess fracture displacement. In this study, a novel 3D measure for fracture displacement is introduced and associated with risk on conversion to total knee arthroplasty (TKA). METHODS: A multicenter cross-sectional study was performed including 997 patients treated for a tibial plateau fracture between 2003 and 2018. All patients were contacted for follow-up and 534 (54%) responded. For all patients, the 3D gap area was determined in order to quantify the degree of initial fracture displacement. A cut-off value was determined using ROC curves. Multivariate analysis was performed to assess the association of 3D gap area with conversion to TKA. Subgroups with increasing levels of 3D gap area were identified, and Kaplan-Meier survival curves were plotted to assess survivorship of the knee free from conversion to TKA. RESULTS: A total of 58 (11%) patients underwent conversation to TKA. An initial 3D gap area ≥ 550 mm2 was independently associated with conversion to TKA (HR 8.4; p = 0.001). Four prognostic groups with different ranges of the 3D gap area were identified: excellent (0-150 mm2), good (151-550 mm2), moderate (551-1000 mm2), and poor (> 1000 mm2). Native knee survival at 10-years follow-up was 96%, 95%, 76%, and 59%, respectively, in the excellent, good, moderate, and poor group. CONCLUSION: A novel 3D measurement method was developed to quantify initial fracture displacement of tibial plateau fractures. 3D fracture assessment adds to current classification methods, identifies patients at risk for conversion to TKA at follow-up, and could be used for patient counselling about prognosis. LEVEL OF EVIDENCE: Prognostic Level III.
PURPOSE: Currently used classification systems and measurement methods are insufficient to assess fracture displacement. In this study, a novel 3D measure for fracture displacement is introduced and associated with risk on conversion to total knee arthroplasty (TKA). METHODS: A multicenter cross-sectional study was performed including 997 patients treated for a tibial plateau fracture between 2003 and 2018. All patients were contacted for follow-up and 534 (54%) responded. For all patients, the 3D gap area was determined in order to quantify the degree of initial fracture displacement. A cut-off value was determined using ROC curves. Multivariate analysis was performed to assess the association of 3D gap area with conversion to TKA. Subgroups with increasing levels of 3D gap area were identified, and Kaplan-Meier survival curves were plotted to assess survivorship of the knee free from conversion to TKA. RESULTS: A total of 58 (11%) patients underwent conversation to TKA. An initial 3D gap area ≥ 550 mm2 was independently associated with conversion to TKA (HR 8.4; p = 0.001). Four prognostic groups with different ranges of the 3D gap area were identified: excellent (0-150 mm2), good (151-550 mm2), moderate (551-1000 mm2), and poor (> 1000 mm2). Native knee survival at 10-years follow-up was 96%, 95%, 76%, and 59%, respectively, in the excellent, good, moderate, and poor group. CONCLUSION: A novel 3D measurement method was developed to quantify initial fracture displacement of tibial plateau fractures. 3D fracture assessment adds to current classification methods, identifies patients at risk for conversion to TKA at follow-up, and could be used for patient counselling about prognosis. LEVEL OF EVIDENCE: Prognostic Level III.
Authors: Brad Meulenkamp; Ryan Martin; Nicholas M Desy; Paul Duffy; Rob Korley; Shannon Puloski; Richard Buckley Journal: J Orthop Trauma Date: 2017-03 Impact factor: 2.512
Authors: Markus Parkkinen; Jan Lindahl; Tatu J Mäkinen; Seppo K Koskinen; Antti Mustonen; Rami Madanat Journal: Injury Date: 2017-11-14 Impact factor: 2.586
Authors: A M L Meesters; J Kraeima; H Banierink; C H Slump; J P P M de Vries; K Ten Duis; M J H Witjes; F F A IJpma Journal: PLoS One Date: 2019-06-19 Impact factor: 3.240
Authors: N Assink; J Kraeima; C H Slump; K Ten Duis; J P P M de Vries; A M L Meesters; P van Ooijen; M J H Witjes; F F A IJpma Journal: Sci Rep Date: 2019-10-07 Impact factor: 4.379