External tibial plateau fracture (AO 41B3/Schatzker2): Analysis of clinical radiological factors in long-term functional and quality of life outcomes after surgical treatment.

INTRODUCTION

The most common tibial plateau fractures are AO 41B3/Schatzker type2 (external unicondylar lesions with a vertical fracture line). The goal of treatment for these fractures is the satisfactory restoration of mechanical alignment, anatomic reduction of the articular surface, and stable fixation to allow early range of motion. The aim of our study is to determine the factors that most influence long-term functional and quality of life outcomes after surgical treatment by strictly selecting previously healthy patients facing an unexpected external tibial plateau fracture.

MATERIAL AND METHOD: A retrospective study was conducted in our tertiary hospital after obtaining approval from the ethics committee. Data from patients with external tibial plateau fracture hospitalized between 2013 and 2018 with more than 3years of evolution were analyzed. All patients who met the strict inclusion criteria completed the KOOS, EQ-5-D profile and VAS questionnaires. In addition, they underwent a physical examination and radiological study using telemetry and computed tomography (CT). The clinical data collected from the patients were: age, sex, fracture side, implant use, graft use, days elapsed until surgery, years after surgery, ASA, range of motion in extension and flexion. The radiological data were: in the telemetry, the deviation in mm of the load axis with respect to the contralateral limb was analyzed, the MPTA of both limbs and the difference in degrees between them; in the CT, the maximum joint step was measured and the affected area was calculated in cm2 as well as the largest anteroposterior diameter and maximum width in mm (maximum anteroposterior and transverse diameters).

RESULTS

A total of 27 patients were analysed, with a mean age of 53.3years and a mean evaluation time since the fracture of 4.8years. We found statistically significant correlations (P<.05) between: days until surgery and size of the area in cm2 (P=.042) and step in mm (P=.028), that is, the more days of delay, the greater the area and the greater the step; being a man presented a positive correlation with having a greater step (P=.025), greater area (P=.007) and greater slope (P=.039) compared to women. A statistically significant relationship was observed between the area of residual fracture and the values of KOOS symptoms (P=.015), KOOS function (P=.012), EQ-5D profile (P=.038) and VAS (P=.049); the greater the affected area, the worse the patient's condition. We also detected significant correlations between increased joint step and KOOS symptoms (P=.005), KOOS pain (P=.026), KOOS activities of daily living (P=.049) and KOOS function (P=.007); the higher the step, the worse the patient's situation.

CONCLUSION

In conclusion, it can be observed that the most important aspect when it comes to obtaining good results in terms of patient satisfaction in the long term is the restoration of the joint line, avoiding large depressions and minimizing the area of residual joint involvement.