Bone metabolism is a key factor for clinical outcome of tibial plateau fractures

Abstract

Purpose Given that tibial plateau fractures (TPF) are rare, they may pose a challenge to the treating surgeon due to their variety of complex fracture patterns. Numerous studies have identified potential fracture-specific, surgery-related, and patient-related risk factors for impaired patient outcomes. However, reports on the influence of bone metabolism on functional outcomes are missing. Methods In a retrospective multicenter cohort study, 122 TPF of 121 patients were analyzed with respect to radiological and clinical outcomes (Rasmussen) with a mean follow-up of 35.7 ± 24.9 months. The risk factor assessment included bone metabolism-affecting comorbidities and medication. Results The findings showed that 95.9% of the patients reported a good-to-excellent clinical outcome, and 97.4% reported a good-to-excellent radiological outcome. Logistic regression revealed that potentially impaired bone metabolism (IBM) was an independent risk factor for the clinical (p = 0.016) but not the radiological outcome (Table 4). Patients with 41-type B fractures and a potential IBM had a seven times higher risk to present a fair-to-poor clinical outcome [OR 7.45, 95 CI (4.30, 12.92)]. The most common objective impairment was a limited range of motion in 16.4% of the patients, especially in 41-type C fractures (p = 0.06). The individual failure analysis additionally identified surgery-related options for improvement. Conclusion This study demonstrated that potential IBM was an independent risk factor for a poor-to-fair clinical outcome.

Tibial plateau fractures: a lot more to come!

“…In a retrospective, multicenter cohort study from the Fracture Committee of the German Knee Society, 122 tibial plateau fractures have been followed clinically and radiographically for almost 3 years. In the current issue, it has been reported that in more than 95% clinical as well as radiological outcomes were good or even excellent [11]. Interestingly, Krause et al found that impaired bone metabolism is an important risk factor for poor outcomes [11].…”

“…In the current issue, it has been reported that in more than 95% clinical as well as radiological outcomes were good or even excellent [11]. Interestingly, Krause et al found that impaired bone metabolism is an important risk factor for poor outcomes [11]. This entity is of high importance as a large percentile of our fractures will be accounted to an elderly population.…”

“…This issue thoroughly presents articles around the tibial plateau [1,6,10,11,[15][16][17]. One important aspect needs, however, further investigations in the future: many surgeons are still focusing mainly on the osseous reconstruction, while soft tissues might be underestimated or even neglected.…”

The influence of 3D printing on inter- and intrarater reliability on the classification of tibial plateau fractures

“…The operative treatment of tibial plateau fractures remains to be a challenging task and current outcomes seem to provide the potential for further improvement [1][2][3][4]. For optimal final results, next to the injury mechanism and the underlying soft tissue trauma, a thorough study of the radiographic imaging material is paramount in the preparation of the surgical strategy [1,5,6]. As practiced in many other anatomic regions, classification systems provide one major foundation Tobias Dust, Maximilian J. Hartel contributed equally and, therefore, share first authorship.…”

Does Time to Theatre Affect the Ability to Achieve Fracture Reduction in Tibial Plateau Fractures?

“…In addition to increased difficulty in manipulating fracture fragments as healing progresses, cancellous bone loss, occurring as early as five days post injury in the fractured tibial plateau [ 3 ], may also contribute to impaired fracture reduction. Maintenance of fracture reduction is multifactorial and may be affected by factors such as fracture severity, bone quality, surgical technique, and patient activities [ 4 , 5 , 6 ]. Indeed, such patient factors may, in some circumstances, lead to options such as total knee replacement or nonoperative management being considered [ 7 ].…”