The long-term functional outcome of operatively treated tibial plateau fractures

Objectives: To review the long-term functional results of the surgical trea tment of tibial plateau fractures using standard techniques of open reducti on and internal fixation. Design: Retrospective study. Setting: University hospital. Methods: Forty-seven displaced fractures of the tibial plateau in forty-six patients were treated with open reduction, inter-fragmental screw fixation of the articular fragments, and buttress plate fixation and had a minimum of five years of followup. All aspects of their care, including tibial plat eau fracture type, operative management and associated injuries, were docum ented. Preoperative and postoperative follow-up radiographs were analyzed f or fracture classification and adequacy of reduction. All patients were con tacted and given functional outcome questionnaires using both a generic hea lth status scale (Short Form 36 [SF-36]) (18) and a disability scale relati ng to knee osteoarthritis (Western Ontario and McMaster Universities Osteoa rthritis index [WOMAC]) (1). Data were also collected regarding return to w ork and sporting activities. Assessment scores were analyzed with respect t o age, fracture type and severity, and were compared to standardized age an d sex-matched scores for the healthy population. The average age of the pat ients at the time of injury was forty years and the average follow-up perio d was 8.3 years. Of the forty-seven fractures studied, twenty-five were cla ssified as Schatzker types I, II, or m, and the remaining twenty-two were t ypes TV, V, or VI (15). All fractures received operative treatment within f orty-eight hours and all but five fractures were acceptably reduced. Results: Compared to the standardized SF-36 categorical and aggregate score s, there was no statistically significant difference between the healthy ag e-matched population and twenty-four of twenty-six of the under-age-forty g roup regardless of fracture type. With regard to the over-age-forty group, scores statistically similar to the control population were found in only t welve of twenty-one patients. Although there was a large variance in WOMAC scores for all groups resulting in no statistically significant difference being found, a trend toward higher categorical and aggregate scores was see n with increasing age at presentation. There was no correlation between WOM AC scores and fracture type. Multiple-classifications analysis of all data revealed that presentation age was the most significant source of variation with respect to functional outcome. Fracture type had much less influence and adequacy of reduction had no significant influence on outcome, although the group of patients having an inadequate reduction by the authors' crite ria was too small in number to reasonably comment upon, Conclusions: Open reduction and internal fixation is a satisfactory techniq ue for the treatment of displaced fractures of the tibial plateau, particul arly for patients younger than forty years.