Bone metabolism is a key factor for clinical outcome of tibial plateau fractures

TY - JOUR

T1 - Bone metabolism is a key factor for clinical outcome of tibial plateau fractures

AU - Krause, Matthias

AU - Alm, Lena

AU - Berninger, Markus

AU - Domnick, Christoph

AU - Fehske, Kai

AU - Frosch, Karl-Heinz

AU - Herbst, Elmar

AU - Korthaus, Alexander

AU - Raschke, Michael

AU - Hoffmann, Reinhard

AU - “Fracture committee” of the German Knee Society

PY - 2020/12

Y1 - 2020/12

N2 - PURPOSE: Given that tibial plateau fractures (TPF) are rare, they may pose a challenge to the treating surgeon due to their variety of complex fracture patterns. Numerous studies have identified potential fracture-specific, surgery-related, and patient-related risk factors for impaired patient outcomes. However, reports on the influence of bone metabolism on functional outcomes are missing.METHODS: In a retrospective multicenter cohort study, 122 TPF of 121 patients were analyzed with respect to radiological and clinical outcomes (Rasmussen) with a mean follow-up of 35.7 ± 24.9 months. The risk factor assessment included bone metabolism-affecting comorbidities and medication.RESULTS: The findings showed that 95.9% of the patients reported a good-to-excellent clinical outcome, and 97.4% reported a good-to-excellent radiological outcome. Logistic regression revealed that potentially impaired bone metabolism (IBM) was an independent risk factor for the clinical (p = 0.016) but not the radiological outcome (Table 4). Patients with 41-type B fractures and a potential IBM had a seven times higher risk to present a fair-to-poor clinical outcome [OR 7.45, 95 CI (4.30, 12.92)]. The most common objective impairment was a limited range of motion in 16.4% of the patients, especially in 41-type C fractures (p = 0.06). The individual failure analysis additionally identified surgery-related options for improvement.CONCLUSION: This study demonstrated that potential IBM was an independent risk factor for a poor-to-fair clinical outcome.

AB - PURPOSE: Given that tibial plateau fractures (TPF) are rare, they may pose a challenge to the treating surgeon due to their variety of complex fracture patterns. Numerous studies have identified potential fracture-specific, surgery-related, and patient-related risk factors for impaired patient outcomes. However, reports on the influence of bone metabolism on functional outcomes are missing.METHODS: In a retrospective multicenter cohort study, 122 TPF of 121 patients were analyzed with respect to radiological and clinical outcomes (Rasmussen) with a mean follow-up of 35.7 ± 24.9 months. The risk factor assessment included bone metabolism-affecting comorbidities and medication.RESULTS: The findings showed that 95.9% of the patients reported a good-to-excellent clinical outcome, and 97.4% reported a good-to-excellent radiological outcome. Logistic regression revealed that potentially impaired bone metabolism (IBM) was an independent risk factor for the clinical (p = 0.016) but not the radiological outcome (Table 4). Patients with 41-type B fractures and a potential IBM had a seven times higher risk to present a fair-to-poor clinical outcome [OR 7.45, 95 CI (4.30, 12.92)]. The most common objective impairment was a limited range of motion in 16.4% of the patients, especially in 41-type C fractures (p = 0.06). The individual failure analysis additionally identified surgery-related options for improvement.CONCLUSION: This study demonstrated that potential IBM was an independent risk factor for a poor-to-fair clinical outcome.

U2 - 10.1007/s00068-020-01537-4

DO - 10.1007/s00068-020-01537-4

M3 - SCORING: Journal article

C2 - 33151357

VL - 46

SP - 1227

EP - 1237

JO - EUR J TRAUMA EMERG S

JF - EUR J TRAUMA EMERG S

SN - 1863-9933

IS - 6

ER -