What is the patient-reported outcome, complication rate and conversion to total knee arthroplasty in patients with tibial plateau fractures caused by high-energy compared to low-energy mechanisms of injury?

Abstract

Purpose: Despite varying impact of high- and low-energy traumas, research comparing patient and fracture characteristics as well as patient-reported functional outcomes following these trauma mechanisms is limited. From a patient, doctor, and legal perspective, assessing the association between trauma mechanism and clinical outcome is important for managing expectations.

Methods: A multicenter cross-sectional study was performed including 1066 patients treated for a tibial plateau fracture between 2003 and 2019. Patients completed the Knee injury and Osteoarthritis Outcomes Score (KOOS) at a mean follow-up of 6 ± 4 years. Trauma mechanisms were classified according to ATLS guidelines. Independent- samples t-test and chi-square test were used to assess differences in patient and fracture characteristics after high- or low-energy trauma. Linear regression analyzed the relationship between trauma mechanisms and KOOS-scores. The Fisher's exact assessed differences in complications and conversion to total knee arthroplasty (TKA).

Results: High-energy trauma mostly occurred in younger males and low-energy trauma in older females. High-energy trauma caused more Schatzker IV-VI fractures, resulted in more initial fracture displacement and needed more often surgical treatment (81% versus 67%; p = 0.002). Linear regression showed that high-energy trauma was associated with lower KOOS-scores. Patients after high-energy trauma had more complications (e.g. revision surgery [8% versus 2%; p = < 0.001], mal- or nonunion [8% versus 2%; p = < 0.001]) and conversion to TKA (15% versus 10%; p = 0.144).

Conclusion: Only 12% of patients with tibial plateau fractures sustained these injuries due to high-energy trauma, which predominantly involved younger males and resulted in more severe fractures. High-energy trauma resulted in worse patient-reported outcomes, more complications, and conversions to TKA.

Level of evidence: Level III, prognostic study.

Keywords: High-energy trauma; KOOS; Low-energy trauma; Patient-reported functional outcome; Tibial plateau fractures; Trauma mechanism.