Sagittal Malalignment and Unsatisfactory Fracture Gap Reduction are Risk Factors for Conversion to Total Knee Arthroplasty After High-Energy Bicondylar Tibial Plateau Fractures.

IF 1.6 3区 医学 Q3 ORTHOPEDICS
Garrett Gordon, Sarah Kurkowski, Samuel Gerak, Nihar Shah, Michael Archdeacon, T Toan Le
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引用次数: 0

Abstract

Objectives: To assess the incidence of and risk factors for conversion to total knee arthroplasty after bicondylar tibial plateau fractures.

Methods: Design: Retrospective, prognostic study.

Setting: Tertiary-referral, single-center, Level I trauma center.

Patient selection criteria: From 2008-2021, patients were included if they had an operative 41C1-C3 tibial plateau fractures and had ≥2 years of follow-up.

Outcome measures and comparisons: Age, sex, BMI, smoking status, injury mechanism, medical history, surgical details (meniscal repair, external fixation, time to fixation), and radiographic data (Kellgren-Lawrence grade, reduction quality (defined as gap <2 mm after reduction), medial proximal tibial angle (MPTA), posterior proximal tibial angle (PPTA)) were collected and compared between patients that went onto require total knee arthroplasty (TKA) and those that did not.

Results: 243 patients were included with mean age of 49.7 (19-89) years and 58.8% were male. Mean follow-up was 5.2±2.6 years. 13.6% (33) required total knee arthroplasty (TKA) after an average of 23.4 months. TKA patients were older (54.0 vs. 49.0 years, p=0.042) and had larger fracture gaps (2.9 vs. 1.7 mm, p=0.024). They also had less satisfactory reductions in fracture gap (42.4% vs. 62.9% achieving reduction with a gap of <2mm, p=0.026) and PPTA (33.3% vs. 61.9%, p=0.002). Risk factors for TKA included fracture gap >2.45 mm after fixation, age >50.5, and PPTA >15°.

Conclusions: Sagittal malalignment, age, and poor fracture gap reduction increased the risk of TKA conversion after OTA41C1-C3 fracture fixation.

Level of evidence: III, prognostic.

矢状位错位和骨折间隙缩小不理想是高能双髁胫骨平台骨折后转行全膝关节置换术的危险因素。
目的:探讨胫骨双髁平台骨折后转全膝关节置换术的发生率及危险因素。方法:设计:回顾性、预后研究。环境:三级转诊,单中心,一级创伤中心。患者选择标准:从2008-2021年,纳入手术41C1-C3胫骨平台骨折且随访≥2年的患者。结果测量和比较:年龄、性别、BMI、吸烟状况、损伤机制、病史、手术细节(半月板修复、外固定、固定时间)、影像学资料(kelgren - lawrence分级、复位质量(定义为间隙))。结果:纳入243例患者,平均年龄49.7(19-89)岁,其中58.8%为男性。平均随访5.2±2.6年。13.6%(33)患者在平均23.4个月后需要全膝关节置换术(TKA)。TKA患者年龄较大(54.0比49.0岁,p=0.042),骨折间隙较大(2.9比1.7 mm, p=0.024)。他们的骨折间隙复位也不太令人满意(42.4%对62.9%),固定后骨折间隙复位为2.45 mm,年龄>为50.5,PPTA >为15°。结论:矢状位错位、年龄、骨折间隙复位不良增加了OTA41C1-C3骨折固定后TKA转换的风险。证据等级:III级,预示预后。
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来源期刊
Journal of Orthopaedic Trauma
Journal of Orthopaedic Trauma 医学-运动科学
CiteScore
3.90
自引率
8.70%
发文量
396
审稿时长
3-8 weeks
期刊介绍: Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.
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