Abstract
PurposeMalunions are a common complication after tibial plateau fractures (TPF), leading to stiffness, pseudo-instability and posttraumatic osteoarthritis. The purpose of this study was to analyse the clinical outcome after intraarticular osteotomy of malunited TPF and to perform a failure analysis.MethodsBetween 2013 and 2018, 23 patients (11 males, 12 females; 43.8 ± 12.8 years) with intraarticular osteotomy after malunited TPF were included in the retrospective study. Clinical examination and postoperative scores were collected with a minimum follow-up of 24 months. Malunion was measured on pre- and postoperative CT scans and localized according to the 10-segment classification while the leg axis in the frontal plane was measured pre- and postoperatively on long leg standing radiographs.ResultsExcellent and good clinical outcome was achieved in 73.9% (n = 17) of the cases and patient related outcome improved significantly (Tegner 3.3 ± 1.6–5 ± 1.8, p < 0.001; clinical Rasmussen 14.6 ± 3.8–24.9 ± 4.4, p < 0.001). Radiological parameters also improved as an intraarticular step-off was reduced from 9 ± 3.8 to 0.6 ± 0.8 mm (p < 0.001) and a lower limb malalignment from 7.2 ± 4.8° to 1.5 ± 1.9° (p = 0.003). Failure analysis showed that an impaired clinical result correlated with a postoperative extension (n = 3, p < 0.001) and flexion deficit (n = 4, p = 0.035).ConclusionIntraarticular osteotomy of malunited TPF lead to good clinical results with significant clinical and radiological improvement in most cases while an impaired patient outcome correlated with a limited range of motion. This study is the first failure analysis of intraarticular osteotomy after malunited TPF published up to now.
Highlights
The treatment of complex tibial plateau fractures (TPF) can be challenging, even for the experienced surgeon while complication rates can rise up to 40% [1, 2]
Malunion after primary osteosynthesis of the TPF often results in dysfunction of the knee as it can lead to chronic subluxation, pseudo-instability, stiffness and posttraumatic osteoarthritis
We hypothesized that intraarticular osteotomy in malunited TPF can lead to good clinical results with significant radiological improvement while limited range of motion is associated with an impaired patient outcome
Summary
The treatment of complex tibial plateau fractures (TPF) can be challenging, even for the experienced surgeon while complication rates can rise up to 40% [1, 2]. Infection of the knee and malunion lead to impaired patient outcome after primary osteosynthesis [3, 4]. Malunion after primary osteosynthesis of the TPF often results in dysfunction of the knee as it can lead to chronic subluxation, pseudo-instability, stiffness and posttraumatic osteoarthritis [5, 6]. The primary aim of this study was to present the outcome of patients treated with intra-articular osteotomy after malunited TPF according to the concept of the 10-segment classification [9, 10]. We hypothesized that intraarticular osteotomy in malunited TPF can lead to good clinical results with significant radiological improvement while limited range of motion is associated with an impaired patient outcome
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