Poor sporting abilities after tibial plateau fractures involving the posterior column: how can we do better?

Purpose: Tibial plateau fractures with the involvement of the posterior column are an important prognostic factor towards poor functional outcome. We aimed to assess the sporting abilities postoperatively with special emphasis on the type of sports and sport-specific movements, as well as time needed to resume sports, restricting factors in sports engagement, and patient satisfaction. We aimed to provide prognostic information on return to sports. Methods: Demographic, clinical and radiological variables were retrospectively collected from 82 multicentric patients between 2014 and 2016. Prospectively, sporting abilities before and after surgery were determined using questionnaires at a mean follow-up of 33 months postoperatively. Results: Involvement in sports significantly decreased, with only 68.4% of patients resuming sports (p < 0.001). The mean time needed to partially or fully resume sports was 6–9 and 9–12 months, respectively. The ability to resume at the pre-injury level of effort and performance was 22% and 12%, respectively. Restricting factors were pain (66%), fear of re-injury (37%), limited range of motion (26%), and instability (21%). The majority (59%) of patients were unsatisfied with their physical abilities. Significantly worse outcomes were observed in patients playing high-impact sports, experiencing knee pain during physical activity, suffering from extension/valgus or flexion/varus trauma. Conclusions: Tibial plateau fractures with the involvement of the posterior column significantly hamper the patients’ sporting abilities, leaving the majority of patients unsatisfied. Preoperative counseling about prognosis, setting realistic expectations, optimizing rehabilitation and pain management postoperatively, and advising low-impact sports might improve engagement in physical activities and emotional impact on patients. Level of evidence: 3

Limited value of the column concept in the operative management of posterior column tibial plateau fractures

INTRODUCTION: The three-column concept has been proposed as tool in surgical decision-making for treating tibial plateau fractures. Recent studies have underscored the negative effect of posterior column tibial plateau fractures on clinical outcome. The purpose of this study was to assess the value of the three-column concept and posterior plating in posterior column fractures. We hypothesized that treating patients according to the three-column concept improves functional outcome. METHODS: 111 consecutive tibial plateau fractures, treated between January 2009 and December 2016, with at least a posterior column fracture were included. Relevant demographic and treatment variables were studied. Applied treatment was retrospectively evaluated according to the three-column concept. Patient reported outcome was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). RESULTS: Median follow-up was 43.1 months (IQR 29.0-63.3) with a response rate of 80.2%. Outcome scores were markedly lower compared to the general population. 22.5% patients were treated according to the three-column concept and 27% was treated with posterior plating. Predominantly combined fractures of posterior and lateral columns were treated without fixation of the posterior column. Neither treatment according to the three-column concept and/or with posterior plating was found to significantly influence outcome. CONCLUSIONS: The outcome of posterior column fractures was equal, regardless of whether these fractures were treated or not. This indicates that the three-column concept seems insufficient and gives rise to further debate on surgical strategies of posterior column fractures. The implementation of trauma mechanism-based fracture morphology in the three-column concept might be important to consummate the three-column concept as guiding tool. LEVEL OF EVIDENCE: 3.status: publishe

Extended lateral column tibial plateau fractures. How do we do it?

We describe the operative management of extended lateral column fractures according to the revised three-column classification approach in a step-by-step fashion. We show that direct reduction and stable fixation of extended lateral column tibial plateau fractures via a limited arthrotomy and tibia condyle osteotomy, with the use of free subchondral 2.7 mm locking screws is a reliable technique. Subsequently, diverging VA-LCP locking screws further improve the structural properties. It is a straightforward technique and the single lateral approach (Lazy-S) facilitates direct reduction of the articular surface and stable fixation of the fracture fragments under direct vision with good radiological and fair functional outcome.status: publishe

Functional outcome and general health status after treatment of AO type 43 distal tibial fractures

Distal tibial fractures are uncommon, but they result in poor overall outcome. The objective of this study was to assess functional outcome and general health status after the treatment of distal tibial fractures and identify factors that affect these outcome measures.publisher: Elsevier articletitle: Functional outcome and general health status after treatment of AO type 43 distal tibial fractures journaltitle: Injury articlelink: http://dx.doi.org/10.1016/j.injury.2016.04.009 content_type: article copyright: © 2016 Elsevier Ltd. All rights reserved.status: publishe

Clinical and Functional Outcome of Proximal Tibial Fractures: The Value of the 3-Column Concept

status: Published onlin

Poor sporting abilities after tibial plateau fractures involving the posterior column: how can we do better?

PURPOSE: Tibial plateau fractures with the involvement of the posterior column are an important prognostic factor towards poor functional outcome. We aimed to assess the sporting abilities postoperatively with special emphasis on the type of sports and sport-specific movements, as well as time needed to resume sports, restricting factors in sports engagement, and patient satisfaction. We aimed to provide prognostic information on return to sports. METHODS: Demographic, clinical and radiological variables were retrospectively collected from 82 multicentric patients between 2014 and 2016. Prospectively, sporting abilities before and after surgery were determined using questionnaires at a mean follow-up of 33 months postoperatively. RESULTS: Involvement in sports significantly decreased, with only 68.4% of patients resuming sports (p < 0.001). The mean time needed to partially or fully resume sports was 6-9 and 9-12 months, respectively. The ability to resume at the pre-injury level of effort and performance was 22% and 12%, respectively. Restricting factors were pain (66%), fear of re-injury (37%), limited range of motion (26%), and instability (21%). The majority (59%) of patients were unsatisfied with their physical abilities. Significantly worse outcomes were observed in patients playing high-impact sports, experiencing knee pain during physical activity, suffering from extension/valgus or flexion/varus trauma. CONCLUSIONS: Tibial plateau fractures with the involvement of the posterior column significantly hamper the patients' sporting abilities, leaving the majority of patients unsatisfied. Preoperative counseling about prognosis, setting realistic expectations, optimizing rehabilitation and pain management postoperatively, and advising low-impact sports might improve engagement in physical activities and emotional impact on patients. LEVEL OF EVIDENCE: 3.status: Published onlin

Posterior tibial plateau fracture treatment with the new WAVE posterior proximal tibia plate: feasibility and first results

Introduction Operative management of posterior tibial plateau fractures (PTPF) remains challenging. The treatment goal is to restore the alignment and articular congruence, and providing sufficient stability which allows early mobilization. The purpose of this study was to assess the feasibility and safety of the newly developed WAVE posterior proximal tibia plate. Methods Between Oct 2017 and Jun 2020, 30 adult patients with a tibial plateau fracture and posterior involvement were selected for treatment with a WAVE posterior proximal tibia plate. Patient reported outcome was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS) at time of injury (pre-injury) and at 1-year follow-up. Radiological outcome was evaluated with CT-imaging. Results Twenty-eight patients were eligible for treatment with the new implant (3 'one-column', 10 'two column' and 15 'three-column' fractures), whereas in 2 patients anatomical fit was insufficient. KOOS results showed fair outcome scores at 1 year, with a large negative impact compared to pre-injury levels; however, a trend towards better results compared to a previous PTPF reference cohort. Radiological follow-up showed insufficient posterolateral buttress in two cases and residual articular step-off (> 2 mm) in seven patients, of which five were classified as three column fractures. Conclusion Management of PTPF using the WAVE posterior proximal tibia plate is feasible and safe with satisfactory clinical and radiological results after 1 year. Nevertheless, there is a learning curve regarding optimal implant positioning to achieve the maximum benefit of the implant