All patients were asked to complete the validated Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire consisting of five subscales: symptoms, pain, activities of daily living (ADL), function in sports and recreation, and knee-related quality of life (QOL). Between 20, 530 patients were treated nonoperatively for tibial plateau fractures, of which 45 had died at follow-up, 30 were younger than 18 years at the time of injury, and 10 had isolated tibial eminence avulsions, leaving 445 patients for follow-up analysis. Some patients with gaps and/or stepoffs exceeding 2 mm might not have had surgery based on shared decision-making. All patients had a diagnostic CT scan, and a gap and/or stepoff more than 2 mm was an indication for recommending surgery. METHODS: A multicenter cross-sectional study was performed in all patients who were treated nonoperatively for a tibial plateau fracture between 20 in four trauma centers. QUESTIONS/PURPOSES: (1) In patients treated nonoperatively for tibial plateau fractures, what is the association between initial fracture displacement, as measured by gaps and stepoffs at the articular surface on a CT image, and functional outcome? (2) What is the survivorship of the native joint, free from conversion to a total knee prosthesis, among patients with tibial plateau fractures who were treated without surgery? Because this is important for patient counseling regarding treatment and prognosis, it is critical to identify the limits of gaps and stepoffs that are well tolerated. However, there is no consensus about the maximum size of gaps and stepoffs on CT images and their relation to functional outcome in skeletally mature patients with tibial plateau fractures who were treated without surgery. It reduces the length of hospital stay and costs, enables early mobilisation with minimal instrumentation, and achieves satisfactory outcomes.BACKGROUND: Gap and stepoff measurements provide information about fracture displacement and are used for clinical decision-making when choosing either operative or nonoperative management of tibial plateau fractures. No patient had any complication (infection, wound dehiscence or hardware problem).Ĭlosed reduction and percutaneous screw fixation for tibial plateau fractures is minimally invasive. The mean Rasmussen score was significantly lower in 12 patients with ligament injury than in 44 patients without ligament injury (19.8 vs. The mean Rasmussen score was 25.7 for all patients it was 27.7 for type I, 26.3 for type II, 28.6 for type IV, and 23.4 for type V fractures. Outcome was satisfactory (good-to-excellent) in 89%, 86%, 100%, and 80% of the respective fracture types of patients. Respectively in Schatzker types-I, -II, -IV, and -V fractures, outcomes were excellent in 6, 10, 2, and 2 patients, good in 2, 9, 3, and 14 patients, fair in 1, 3, 0, and 2 patients, and poor in 0, 0, 0, and 2 patients. All the fracture united radiographically after a mean of 3 (range, 2.5-4.2) months. The mean length of hospital stay was 5 (range, 2-15) days. Patients were followed up for a mean of 2.8 (range, 1-4) years. A total score of 28 to 36 was considered as excellent, 20 to 27 as good, 10 to 20 as fair, and <10 as poor. Functional outcome (pain, walking capacity, extension lag, range of motion, and stability) was evaluated using the Rasmussen score. Reduction was fixed percutaneously with cancellous screws (6.5 mm) and washers. Closed reduction was achieved using manual ligamentotaxis with traction in extension under image intensifier control. According to the Schatzker classification, patients were classified into type I (n=9), type II (n=22), type IV (n=5), and type V (n=20). To evaluate treatment outcomes of closed reduction and percutaneous screw fixation for tibial plateau fractures.Ĥ8 men and 8 women aged 19 to 61 (mean, 36) years underwent closed reduction and percutaneous screw fixation for closed tibial plateau fractures with <5 mm depression.
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