Influence of reduction quality on functional outcome and quality of life in the surgical treatment of tibial plateau fractures: a retrospective cohort study.

BACKGROUND: Despite a substantial improvement in the operative treatment of tibial plateau fractures, the surgical procedure remains controversial and is generally challenging, as patients may develop postoperative arthritis and functional impairment of the knee joint.

HYPOTHESIS: In the surgical treatment of tibial plateau fractures the intraoperative reposition quality has the greatest influence on the postoperative outcome, whereby misalignments of >/= 2 mm lead to a worse result.

PATIENTS AND METHODS: 41 patients with tibial plateau fractures were postoperatively examined. The operative treatment was performed under reduction control using an intraoperative 3D C-arm. The follow-up collective was divided into two groups depending on the intraoperative reduction result. The postoperative results were then evaluated using the following parameters: Lysholm score, Rasmussen score, Tegner score, SF-36 score, range of motion and pain level.

RESULTS: Group 1 (articular surface incongruencies <2 mm) tended to achieve a better result in all scores than group 2 (articular surface incongruencies >/=2 mm), in the Lysholm score (p=0.039), in the comparison of the range of motion (p=0.012) and the pain level (p=0.039) this was significant. Group 1 achieved an average of 90.71 points (group 2: 78.74) in the Lysholm score. The average range of motion of the knee joint was 138.93° in group 1 (group 2: 127.78°). The average value of the current pain level in group 1 was 1.14 (group 2: 2.63).

DISCUSSION: Both study groups achieved a very good result compared to the available literature. It appears that reduction quality -which can be analyzed with intraoperative 3D imaging- plays the most important role in postoperative quality of life and functional outcome. Intraoperative adjustments of the reduction should therefore be performed on joint surface irregularities with a size above 2 mm.

LEVEL OF EVIDENCE: III; Retrospective case control study.