Intraarticular osteotomy of malunited tibial plateau fractures: an analysis of clinical results with a mean follow-up after 4 years

Abstract

Purpose Malunions 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. Methods Between 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. Results Excellent 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). Conclusion Intraarticular 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.

Complications of the surgical treatment of fractures of the tibial plateau: prevalence, causes, and management

“…In combined malunions, several techniques can be combined, and treatment should be performed in two stages separated by 3-6 months to ensure consolidation (91). Table 4 shows a summary of the results from the literature on the treatment of malunions (94,96,97,98,99,100).…”

Clinical results after very early, early and late arthroscopic arthrolysis of the knee

“…It is commonly known that persistent post-operative knee stiffness results in impaired patient-related outcome [4,16,17]. Previous studies demonstrated that impaired postoperative functional scores correlated with a post-operative extension and flexion deficit in primary and revision osteosynthesis of tibial head fractures [3,5]. Also, Mayr et al showed that patients with post-operative motion loss suffered from long-term complications: thus, nearly 80% of their patients with arthrofibrosis showed signs of osteoarthritis in the femoro-tibial joint five years after arthroscopic arthrolysis [14].…”

“…When the ACL reconstruction (ACLR) is combined with an open reconstruction of the medial collateral ligament (MCL), the incidence of post-operative motion loss is even higher with rates up to 13% [1,2]. Following the surgical treatment of tibial plateau fractures (TPF), the rate of a loss of motion was shown to be 14%, and after revision procedures, it may even raise up to 50% of the cases [1,[3][4][5].…”

Tibial plateau fractures: a lot more to come!

“…In these cases, osteotomy might be a good but technically demanding treatment option. In the article "Intraarticular osteotomy of malunited tibial plateau fractures: an analysis of clinical results with a mean follow-up after 4 years ", the authors reported on good outcomes with proper realignment of the lower limb axis as well as intra-articular step-offs 4 years after an osteotomy due to malreduction or non-union [1]. Nevertheless, these procedures should be limited to experts and centers with a high case load.…”

“…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.…”