Long-term outcomes after open reduction and internal fixation of bicondylar tibial plateau fractures

Yassine Ochen; Jesse Peek; Michael F McTague; Michael J Weaver; Detlef van der Velde; R Marijn Houwert; Marilyn Heng

doi:10.1016/j.injury.2020.03.003

Long-term outcomes after open reduction and internal fixation of bicondylar tibial plateau fractures

Injury. 2020 Apr;51(4):1097-1102. doi: 10.1016/j.injury.2020.03.003. Epub 2020 Mar 2.

Authors

Yassine Ochen¹, Jesse Peek¹, Michael F McTague², Michael J Weaver², Detlef van der Velde³, R Marijn Houwert⁴, Marilyn Heng⁵

Affiliations

¹ Department of Orthopaedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston, USA; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
² Department of Orthopaedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Boston, USA.
³ Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands.
⁴ Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
⁵ Department of Orthopaedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston, USA. Electronic address: mheng@mgh.harvard.edu.

PMID: 32147141
DOI: 10.1016/j.injury.2020.03.003

Abstract

Introduction: To establish normative data, long-term patient-reported functional outcome and health-related quality of life (HrQoL) after operative treatment of bicondylar tibial plateau fractures. Secondly, to identify risk factors associated with functional outcome and HrQoL.

Patients and methods: We performed a retrospective cohort study at two Level I trauma centers. All adult patients with AO/OTA 41-C or Schatzker V/ VI tibial plateau fractures treated between 2001 and 2016 (n = 450) by open reduction internal fixation (ORIF). The survey was completed by 214 patients (48%). Primary outcome was patient-reported functional outcome assessed with the PROMIS Physical Function (PROMIS PF). Secondary outcomes were HrQoL measured with the EuroQol 5-Dimensions 3-Levels (EQ-5D-3 L), infection rate, and total knee arthroplasty (TKA) rate.

Results: Infection occurred in 26 cases (12%) and TKA was performed in 6 patients (3%). The median PROMIS PF scores was 49.8 (IQR;42-54). The median EQ-5D-3 L was 0.83 (IQR;0.78-1.0).%). The multivariable regression model revealed female gender, diabetes, and worse HrQoL were correlated with worse functional outcome. The multivariable regression model revealed smoking, diabetes, and the subsequent need for TKA to be correlated with worse HrQoL.

Conclusion: The PROMIS PF and EQ-5D-3L did not reach a minimum clinically important difference. The PROMIS PF items revealed patients had no difficulty in walking more than a mile or climbing a flight of stairs. However, patients were limited in doing vigorous activities and patients should be counseled about the expected long-term outcomes. This study emphasizes the correlation between injury specific functional outcome measures and general health measures.

Level of evidence: Therapeutic Level III.

Keywords: Bicondylar; EQ-5D-3L; Fracture; ORIF; PROMIS; Tibial plateau.

Publication types

Comparative Study
Multicenter Study

MeSH terms

Adult
Arthroplasty, Replacement, Knee / statistics & numerical data*
Female
Fracture Fixation, Internal / methods*
Fracture Healing
Humans
Male
Middle Aged
Multivariate Analysis
Open Fracture Reduction / methods*
Patient Reported Outcome Measures
Quality of Life
Regression Analysis
Retrospective Studies
Severity of Illness Index
Surveys and Questionnaires
Tibial Fractures / surgery*
Trauma Centers