Do radiographic and functional results correlate after fixation of Schatzker V-VI tibial plateau fractures?
Kenneth A. Egol1, Monet France1, Nirmal C. Tejwani1, Toni McLaurin1, Kenneth J. Koval2
1Department of Orthopaedic Surgery, The New York University Hospital for Joint Diseases
2Department of Orthopaedic Surgery, Dartmouth Medical Center
Keywords: External fixators; fracture fixation, internal; knee injuries/surgery; postoperative complications; tibial fractures/classification/surgery/radiography; treatment outcome.
Objectives: High-energy tibial plateau fractures are complex injuries that have varying outcomes. Our purpose was to evaluate outcomes of operatively treated Schatzker type V and VI tibial plateau fractures and compare them to the radiographic results.
Patients and methods: Eighty consecutive patients underwent operative treatment for Schatzker type V (21 fractures) or type VI (62 fractures) tibial plateau fractures. There were 64 closed (77.1%) and 19 open fractures (22.9%), with 11 extremities (13.3%) having compartment syndrome. Fifteen patients (18.8%) with 18 fractures were lost to follow-up. Finally, 65 patients with 65 extremities were available for clinical and radiographic examinations after a mean follow-up of 17 months (range 10 to 40 months). Functional assessments were made using the WOMAC (Western Ontario and McMaster Universities Arthritis Index) questionnaire.
Results: The mean range of knee motion at the latest follow-up was 1° (0° to 20°) - 115° (60° to 140°) and the mean WOMAC score was 76.6±55. Radiographically, 15 knees (23.1%) had evidence for collapse and 11 patients (16.9%) had evidence for post-traumatic arthritis. Both loss of fracture reduction (p=0.001) and arthritic changes (p=0.04) were associated with a poorer functional score on the WOMAC. Complications included five deep wound infections (7.7%), two nonunions (3.1%), and 10 patients required additional unplanned surgery (15.4%).
Conclusion: Early loss of surgical reduction and development of radiographic evidence for arthritic changes are predictors of functional scores in Schatzker type V and VI tibial plateau fractures.