Klöppner, S.A. (2020) The long-term functional outcome of nonoperatively treated tibial plateau fractures. Are conventional CT and 3D CT gap and step-off measurements good predictors for long-term physical functioning? thesis, Medicine.
Full text available on request.Abstract
Background Tibial plateau fractures are challenging fractures in which adequate treatment is crucial for minimizing the risk on patient disability due to progressive posttraumatic arthritis. Indication for operative or nonoperative treatment is mainly based on the degree of intra-articular gap and step-off displacement. Yet, there is no general consensus on what amount of gap or step-off warrants an indication for operative treatment. To our best knowledge, there is no literature available comparing intra-articular measurements with functional outcome after nonoperative treatment of tibial plateau fractures. Questions/purposes (1) Is there a significant difference in long-term functional outcome between patients with nonoperatively treated tibial plateau fractures and the general population? (2) Is there an association between the intra-articular gap and step-off measured on CT-scans and the functional outcome after nonoperative treatment of tibial plateau fractures? (3) Is there a stronger association between the articular involvement and 3D gap area measured in 3D CT-scans compared to intra-articular gap and step-off measured in 2D CT scans and the functional outcome in the patient? Methods In this retrospective cohort study we included 92 patients (mean age 52; SD 16.6) from three level 1 trauma centers treated between 2003-2018. The mean follow-up duration was 67 months (SD 34.6). The long-term patient-reported physical functioning was reported according to the five subscales: symptoms, pain, daily activities, sport and quality of life of the Knee injury and Osteoarthritis Outcome Score (KOOS). The physical functioning of nonoperatively treated patients was compared with data from age-matched peers from the general population. Subsequently, the physical functioning of patients with an intra-articular gap <2 mm gap measured on 2DCT was compared to than patients with a gap ≥2 mm. The same analysis was repeated for patients with a step-off <2 mm compared to patients with a step-off ≥2 mm. To assess the additional value and relationship between 3D CT measurements and physical functioning, patients with a gap area <100 mm2 were compared to patients with a gap area ≥100 mm2. Results Patients who have been treated nonoperatively for a tibial plateau fracture, do not perform significantly different than their age-matched peers in the general population after a mean follow up of 5.6 years (SD 2.9). When comparing intra-articular measurements, functional outcome in the five KOOS subscales did not differ significantly between patients with an intra-articular gap or step-off <2 mm compared to patients with a gap or step-off ≥2 mm. We found that patients with a gap area ≥100mm2 experience significantly more pain in their knee (P=0.02) and report significantly more trouble with daily activities(P=0.03) and a lower quality of life (P=0.03) than the patients with gap area <100mm2. 4 Conclusion This study shows that the current nonoperative treatment is a valid treatment option for tibial plateau fracture resulting in comparable functional outcomes as their age-matched peers. This shows that nonoperative treatment of minimally displaced tibial plateau fractures is definitely a valid option. The widely used cut-off value of 2 mm gap or step-off could not be correlated to functional outcome, and nonoperative treatment might be underutilized with the current cut-off. The 3D CT measurement of gap area, did show to be a more accurate determining factor for functional outcome compared to conventional CT. Patients with an intra-articular gap area < 100mm2 had significantly less pain, less trouble during daily activities and significantly better knee related quality of life than patients with a gap area ≥100mm2. With superior accuracy and reliability 3D CT measurements can help physicians make more evidence based treatment decisions in the future.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | dr. IJpma, F.F.A |
| Faculty: | Medical Sciences |
| Date Deposited: | 09 Jan 2024 12:32 |
| Last Modified: | 09 Jan 2024 12:32 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3734 |
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