A Register Analysis after Tibial Plateau Fracture in Statutory Accident Insurance

OBJECTIVE: To analyse the results after tibial plateau fractures with a focus on socioeconomic consequences.

METHODS: On the basis of the data from the rehabilitation documentation of the German Statutory Accident Insurance (DGUV) on tibial plateau fractures (Code 83), a retrospective anonymised evaluation of the injuries which occurred in 2010 and 2016 was carried out. The registry data allowed subdivision into 3 groups: Medial, lateral and bicondylar tibial plateau fractures. The data have been analysed with regard to the following parameters: age, gender, treatment, time of return to work (AU), costs per case, total costs, workers compensation (MdE) and total payments.

RESULTS: The analysis includes 1046 isolated tibial plateau fractures for 2010 and 1072 for 2016. In 2016, 798 fractures could be assigned to the medial, lateral or bicondylar fracture groups. In 551 cases, both condyles were involved. In another 221 cases, the lateral plateau and in 26 the medial plateau was injured. There were 476 (59.7%) men and 322 (40.4%) women. The mean age was 43.4 (SD ± 16.7) years with a peak of 180 cases in the 55-60 year subgroup and 98 aged 15-20 years. The mean age of the cases with isolated lateral plateau involvement was 48.1 (SD ± 13.8) and was 47.5 (SD ± 16.6) in those with medial plateau fractures and 41.4 (SD ± 17.2) years in the subgroup with bicondylar patterns. The mean time of return to work was 39.4 (SD ± 25.3) weeks for the bicondylar tibial plateau fractures, 28.1 (SD ± 27.2) weeks for the medial and 24.5 (SD ± 22.8) weeks for the lateral groups. For the 2016 group, the mean costs were 5212 € for outpatient, 10358 € for inpatient and 7622 € for rehab costs per case (total costs over three years of 4247443 € for outpatient and 7506508 € for acute inpatient treatment). The highest costs per case were caused by the inpatient acute treatment of bicondylar tibial plateau fractures, at a mean of 22292 €. 17.6% of the 2016 casualty group resulted in compensation of at least 20%. The treatment costs for the 2010 group over 9 years (2010-2019) amounted to 4190855 € for outpatient treatments and € 9565313 for inpatient treatments. In addition, compensations of 8632448 € and lump-sum payments of 483289 € were paid from 2010 to 2019. Over a period of 9 years, 456 (66%) of 692 patients needed another in patient follow-up treatment. A total of 51% (n = 353) needed these treatments within the first year.

CONCLUSION: Tibial plateau fractures, in particular bicondylar tibial plateau fractures, show long-term, cost-intensive healing processes with reduced occupational capacity. Tibial plateau fractures are of economic importance in the statutory accident insurance in the long term. Preventive measures, optimal care and rehabilitation are therefore essential, together with innovative research to improve clinical outcomes.