Mittelfristige Ergebnisse zur Lebensqualität nach operativer Versorgung von Tibiakopffrakturen vom Typ Moore V

Abstract

Dislocation fractures of the tibial plateau often lead to functional restrictions and subjective complaints from the patients. Besides functional and radiological results, criteria to determine the quality of life are of increasing importance. Intermediate term restriction in quality of life was evaluated and correlated with objective radiological results in patients with Moore type V dislocation fracture of the tibial plateau. From 2003 to 2012, a multicentre retrospective cohort study in three hospitals was used to register 36 patients with 38 Moore type V dislocation fractures of the tibial plateau. The injury mechanism, the surgical treatment (one step or two step surgery, single or double plate fixation) the complication rate, the radiological result (Kellgren/Lawrence osteoarthritis score, loss of reduction, secondary deviation of the axis) after a mean follow-up of 37 months, and the quality of life (pain and function by NRS, IKDC form, EQ 5D score) after a mean follow-up of 68 months (range, 15-128 months), were analysed. The mean age of the 27 men and the 9 women was 50.8 years. There were 30 cases of high impact injury. An external fixator was used for primary fracture stabilisation in 24 knees; definitive internal fixation was performed in a second step. Internal fixation using a single plate was used in 12 knees, and double plate fixation in 25 knees; one patient was treated definitively with an external fixator. Early complications (3 × infection, 2 × compartment syndrome, 4 × implant failure) were seen in 21.1 % of patients; all could be cured surgically. The function of the affected knee joint gave a mean NRS of 4.53; the IKDC score was 50.46, and the EQ 5D 7.47. Only two patients (5 %) were free of pain, 27 (75 %) reported mild to moderate pain, and 7 patients (20 %) reported severe pain. Four patients are retired or have applied for a pension. Altogether, the quality of life was calculated as being 44 % of the initial value before the injury. Four patients required an endoprosthetic replacement at an early stage, after an average of 6 months. Signs of osteoarthritis (Kellgren/Lawrence> I) were seen in 32 of the remaining 33 fractures; 19 of these exhibited distinct signs of osteoarthritis (Kellgren/Lawrence III, IV). Loss of reduction (≥ 2 mm) was seen in 13 (34.2 %) and deviation of axis (> 10°) in 3 patients (7.8 %). There was no relation to the surgical strategy. However, there was a correlation between the subjective assessments of the quality of life and the radiological results. Moore type V dislocation fractures of the tibial plateau are severe knee injuries resulting in a distinct reduction in quality of life in the intermediate term. There is a correlation between the subjective assessments and the objective radiological results. Therefore, the congruency of the articular surface and the axis have to be reconstructed as precisely as possible when repairing fractures of the tibial plateau.

Patients with complex proximal tibial fractures overestimate the prognosis of their injury

“…In a study by Evangelopoulos et al evaluating mid-term results after proximal tibial fracture, 77% of the patients reported pain or discomfort in the affected knee joint within 56 months (mean) after proximal tibial fracture [11]. Severe injury of the tibia frequently leads to residual pain or limited knee function [12]. In this study, Wirbel et al evaluated life quality after proximal tibial fracture.…”