Tibial Plateau Fracture Surgical Care Using Standardized Protocols Over Time: A Single Center's Longitudinal View

Abstract

OBJECTIVE: To report on demographics, injury patterns, management strategies, and outcomes of patients who sustained fractures of the tibial plateau seen at a single center over a 16-year period. DESIGN: Prospective collection of data. PATIENTS/PARTICIPANTS: 716 patients with 725 tibial plateau fractures, were treated by one of 5 surgeons. INTERVENTION: Treatment of tibial plateau fractures. MAIN OUTCOME MEASUREMENTS: Outcomes were obtained at standard time-points. Complications were recorded. Patients were stratified into 3 groups: those treated in the first 5 years, those treated in the second 5 years, and those treated in the most recent 6 years. RESULTS: Six hundred eight fractures were followed for a mean 13.4 months (6-120) and 82% had a minimum 1-year follow-up. Patients returned to self-reported baseline function at a consistent proportion during the 3 time periods. The average knee arc was 125 degrees (75-135 degrees) at latest follow-up and did not differ over time. The overall complication rate after surgery was 12% and did not differ between time periods. Radiographs demonstrated excellent rates of healing and low rates of post-traumatic osteoarthritis and improved articular reductions at healing (0.58 mm in Group 3 compared with 0.94 mm in Group 1 and 1.12 mm in Group 2) ( P < 0.05). CONCLUSIONS: Most patients regained their baseline functional status after surgical intervention and healing. Over time the ability of surgeons to achieve a more anatomic joint reduction was observed; however, this did not correlate with improved functional outcomes. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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