Mismatch between Clinical–Functional and Radiological Outcome in Tibial Plateau Fractures: A Retrospective Study

Abstract

Background: The evaluation of tibial plateau fractures (TPF) encompasses the assessment of clinical–functional and radiological parameters. In this study, the authors aimed to investigate the potential correlation between these parameters by utilizing both the clinical–functional and the modified radiological Rasmussen score. Methods: In this retrospective monocentric study conducted at a level-I trauma center, patients who underwent surgery between January 2014 and December 2019 due to a TPF were included. The clinical–functional Rasmussen score prior to the injury, at 1-year postoperatively, and during the last follow-up (minimum 18 months) was assessed using a standardized questionnaire. Additionally, the modified radiological Rasmussen score was determined at the 1-year postoperative mark using conventional radiographs in two planes. Results: A total of 50 patients were included in this study, comprising 40% (n = 20) men, and 60% (n = 30) women, with an average age of 47 ± 11.8 years (range 26–73 years old). Among them, 52% (n = 26) had simple fractures (classified according to Schatzker I–III), while 48% (n = 24; according to Schatzker IV–VI) had complex fractures. The mean follow-up was 3.9 ± 1.6 years (range 1.6–7.5 years). The functional Rasmussen score assessed before the injury and at follow-up showed an “excellent” average result. However, there was a significant difference in the values of complex fractures compared to before the injury. One year postoperatively, both the clinical–functional score and the modified radiological score demonstrated a “good” average result. The “excellent” category was more frequently observed in the functional score, while the “fair” category was more common in the radiological score. There was no agreement between the categories in both scores in 66% of the cases. Conclusions: The data from this retrospective study demonstrated that patients with TPF are able to achieve a nearly equivalent functional level in the medium-term after a prolonged recovery period, comparable to their pre-injury state. However, it is important to note that the correlation between clinical–functional and radiological parameters is limited. Consequently, in order to create prospective outcome scores, it becomes crucial to objectively assess the multifaceted nature of TPF injuries in more detail, both clinically and radiologically.

Patient-Reported Outcomes following Tibial Plateau Fractures: Mid- to Short-Term Implications for Knee Function and Activity Level

“…However, complex fractures are known to be associated with numerous complications that significantly impact the functional outcome of the fracture [30]. Furthermore, this study supports the existing research showing a lack of correlation between fracture classification and outcomes, such as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score or the severity of post-traumatic osteoarthritis [13,14].…”

“…The literature categorizes TPFs into high-/complex-and low-/simple-energy fractures [11,12]. Interestingly, there is no significant correlation between radiological and functional outcomes [13,14]. However, the majority of patients can achieve good to excellent functional results in the short and long term [13,[15][16][17][18][19][20][21].…”

Comparison of functional outcome of locking plate technique versus hybrid Ilizarov technique for complicated tibial plateau fractures

“…Regular check-ups radiological evaluations and functional outcomes were determined by Rasmussen clinicalfunctional assessment score. Scores were graded as Excellent (27-30), Good (20)(21)(22)(23)(24)(25)(26), Fair (10)(11)(12)(13)(14)(15)(16)(17)(18)(19), and Poor (<10). 13 Any incidence of infection was reported and compared.…”

“…Scores were graded as Excellent (27-30), Good (20)(21)(22)(23)(24)(25)(26), Fair (10)(11)(12)(13)(14)(15)(16)(17)(18)(19), and Poor (<10). 13 Any incidence of infection was reported and compared. Time for union in both groups was compared, and non-union incidence was reported.…”

“…12 Studies evaluating Rasmussen's knee functional outcome demonstrate varying results with the hybrid Ilizarov technique and locking plate approach. 13,14 This research aims to contribute to the existing knowledge by comparing the functional outcomes of patients undergoing the locking plate approach versus the hybrid Ilizarov technique for complicated tibial plateau fractures. Given the scarcity of local studies on this issue, the findings of this research are anticipated to enhance the understanding and treatment of such fractures in the future.…”