A midterm analysis of Tibial plateau fractures: functional outcome and incidence of osteoarthritis in 240 cases

Abstract

Background: Tibial plateau fractures are a risk to the functional integrity of the knee. They are the result of axial compressive forces alone or combined with varus or valgus stress on the knee joint. Post-traumatic osteoarthritis occurs after traumatic injury to the joint. The presence of residual incongruity at the time of fracture healing could lead to joint stiffness and long-term morbidity has established the restoration of articular congruity as the key principle on the management of these injuries. Despite anatomical joint reconstruction, development of osteoarthritis may still occur secondary to the initial articular cartilage injury. This prospective study evaluates the functional and radiological outcome of surgically managed tibial plateau fractures and incidence of osteoarthritis. Methods: In this study 240 patients with tibial plateau fractures were surgically managed by different modalities. The study was prospective, patients were evaluated by Rasmussen criteria clinically and radiologically and Kellgren & Lawrence grading for development of osteoarthritis at 6 weeks, 3 months, 6 months, then onwards regular OPD follow-up and latest final follow-up. Results: Rasmussen clinical scoring system was applied to our study showed excellent results in around 34% (82) of the patients, 53% (127) had good,9% (22) had fair and 4% (9) had poor results.Out of 240 patients 78 (32.5%) developed OA knee ( including Kellgren and Lawrence grade 1) which is a significant number of patients. With increase in schatzker type & amount of articular depression the number of patients developing Osteo arthritis increased, schatzker Type I 16 % vs schatzker Type VI 54% and no articular depression 9.5% vs > 5mm articular depression 46 %. Conclusion: With increase in schatzker type & amount of articular depression the chance of patient developing Osteoarthritis significantly increases and thus excellent anatomical reduction with restored articular congruity rigid fixation is required to facilitate early knee motion and reduces chance post-traumatic osteoarthritis and thus achieving optimal knee function. Keywords: Tibial Plateau fracture, post-traumatic arthritis, Proximal tibia Fracture.