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Correlation between preoperative imaging parameters and postoperative basic kinematics-based functional outcome in patients with tibial plateau fractures

      Highlights

      • Tibial plateau fractures are associated with accelerated knee joint degeneration.
      • The study investigates correlation between fracture characteristics and gait parameters.
      • Higher number of fracture fragments negatively correlates with velocity and cadence.
      • Affected limbs had shorter step length and single-limb support times.

      Abstract

      Background

      Functional scores and radiographs are often used to assess function and predict development of osteoarthritis in patients with multi-fragmentary tibial plateau fractures (TPFs). Locomotion, which is the primary goal of fracture treatment, is rarely assessed. The objective of this study was to assess functional ability of patients after TPF fixation using spatio-temporal gait analysis (STGA), and to compare STGA variables with self-reported functional scores and preoperative fracture characteristics.

      Methods

      Preoperative CT scans of 21 patients with complete articular multi-fragmentary TPFs were evaluated for number of fragments, maximum gap between the fragments and maximum articular depression. All patients underwent STGA (velocity, cadence, step length of the affected and the unaffected leg, single-limb support by the affected and the unaffected leg, and double-leg support) and filled the Knee Society Score and the Short Form-12 questionnaires on average 3 years (SD = 1.56, range, 2–5.8) post-injury.

      Findings

      Step length and single-limb support time of the affected leg were shorter compared to the unaffected leg (p = 0.02 and p = 0.007, respectively). Number of fracture fragments correlated with cadence (R = −0.461, p = 0.04) and velocity (R = −0.447, p = 0.04).

      Interpretation

      Given that both higher fracture comminution and deformity on the one hand and the above gait parameter alterations on the other hand are associated with knee osteoarthritis, STGA may be used for routine postoperative evaluation of patients after TPF fixation.

      Keywords

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      References

        • Ali A.M.
        • El-Shafie M.
        • Willett K.M.
        Failure of fixation of tibial plateau fractures.
        J. Orthop. Trauma. 2002; 16: 323-329
        • Amir M.
        • Lewin-Epstein N.
        • Becker G.
        • Buskila D.
        Psychometric properties of the SF-12 (Hebrew version) in a primary care population in Israel.
        Med. Care. 2002; 40: 918-928https://doi.org/10.1097/01.MLR.0000027359.33761.FA
        • Astephen J.L.
        • Deluzio K.J.
        • Caldwell G.E.
        • Dunbar M.J.
        • Hubley-Kozey C.L.
        Gait and neuromuscular pattern changes are associated with differences in knee osteoarthritis severity levels.
        J. Biomech. 2008; 41: 868-876https://doi.org/10.1016/j.jbiomech.2007.10.016
      1. Baker, R., n.d. Measuring Walking: A Handbook of Clinical Gait Analysis.

        • Chang A.
        • Hurwitz D.
        • Dunlop D.
        • Song J.
        • Cahue S.
        • Hayes K.
        • Sharma L.
        The relationship between toe-out angle during gait and progression of medial tibiofemoral osteoarthritis.
        Ann. Rheum. Dis. 2007; 66: 1271-1275https://doi.org/10.1136/ard.2006.062927
        • Deleanu B.
        • Prejbeanu R.
        • Crisan D.
        • Predescu V.
        • Popa I.
        • Poenaru D.V.
        Gait characteristics before hardware removal in patients operated upon for tibial plateau fractures.
        Int. Orthop. 2015; 39: 1411-1415https://doi.org/10.1007/s00264-015-2691-0
        • Drexler M.
        • Gross A.
        • Dwyer T.
        • Safir O.
        • Backstein D.
        • Chaudhry H.
        • Goulding A.
        • Kosashvili Y.
        Distal femoral varus osteotomy combined with tibial plateau fresh osteochondral allograft for post-traumatic osteoarthritis of the knee.
        Knee Surg. Sports Traumatol. Arthrosc. 2015; 23: 1317-1323https://doi.org/10.1007/s00167-013-2828-x
        • Elbaz A.
        • Mor A.
        • Segal G.
        • Debi R.
        • Shazar N.
        • Herman A.
        Novel classification of knee osteoarthritis severity based on spatiotemporal gait analysis.
        Osteoarthr. Cartil. 2014; 22: 457-463https://doi.org/10.1016/j.joca.2013.12.015
        • Elsoe R.
        • Larsen P.
        Asymmetry in gait pattern following bicondylar tibial plateau fractures—a prospective one-year cohort study.
        Injury. 2017; 48: 1657-1661https://doi.org/10.1016/j.injury.2017.04.045
        • Harrington I.J.
        WSIAT | Symptoms in the Opposite or Uninjured Leg.
        WWW Document, 2005 (accessed 3.17.18)
        • Insall J.N.
        • Dorr L.D.
        • Scott R.D.
        • Scott W.N.
        Rationale of the knee society clinical rating system.
        Clin. Orthop. Relat. Res. 1989; : 13-14
        • Loibl M.
        • Bäumlein M.
        • Massen F.
        • Gueorguiev B.
        • Glaab R.
        • Perren T.
        • Rillmann P.
        • Ryf C.
        • Naal F.D.
        Sports activity after surgical treatment of intra-articular tibial plateau fractures in skiers.
        Am. J. Sports Med. 2013; 41: 1340-1347https://doi.org/10.1177/0363546513489524
        • Manidakis N.
        • Dosani A.
        • Dimitriou R.
        • Stengel D.
        • Matthews S.
        • Giannoudis P.
        Tibial plateau fractures: functional outcome and incidence of osteoarthritis in 125 cases.
        Int. Orthop. 2010; 34: 565-570https://doi.org/10.1007/s00264-009-0790-5
        • Morin V.
        • Pailhé R.
        • Duval B.R.
        • Mader R.
        • Cognault J.
        • Rouchy R.-C.
        • Saragaglia D.
        Gait analysis following medial opening-wedge high tibial osteotomy.
        Knee Surgery, Sport. Traumatol. Arthrosc. 2018; 26: 1838-1844https://doi.org/10.1007/s00167-017-4421-1
        • Rademakers M.V.
        • Kerkhoffs G.M.M.J.
        • Sierevelt I.N.
        • Raaymakers E.L.F.B.
        • Marti R.K.
        Operative treatment of 109 tibial plateau fractures: five- to 27-year follow-up results.
        J. Orthop. Trauma. 2007; 21: 5-10https://doi.org/10.1097/BOT.0b013e31802c5b51
        • Scanlan S.F.
        • Favre J.
        • Andriacchi T.P.
        The relationship between peak knee extension at heel-strike of walking and the location of thickest femoral cartilage in ACL reconstructed and healthy contralateral knees.
        J. Biomech. 2013; 46: 849-854https://doi.org/10.1016/j.jbiomech.2012.12.026
        • Stevens D.G.
        • Beharry R.
        • McKee M.D.
        • Waddell J.P.
        • Schemitsch E.H.
        The long-term functional outcome of operatively treated tibial plateau fractures.
        J. Orthop. Trauma. 2001; 15: 312-320
        • Turcot K.
        • Armand S.
        • Lübbeke A.
        • Fritschy D.
        • Hoffmeyer P.
        • Suvà D.
        Does knee alignment influence gait in patients with severe knee osteoarthritis?.
        Clin. Biomech. 2013; 28: 34-39https://doi.org/10.1016/j.clinbiomech.2012.09.004
        • Urruela A.
        • Davidovitch R.
        • Karia R.
        • Khurana S.
        • Egol K.
        Results following operative treatment of tibial plateau fractures.
        J. Knee Surg. 2012; 26: 161-166https://doi.org/10.1055/s-0032-1324807
        • Ware J.
        • Kosinski M.
        • Keller S.D.
        A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity.
        Med. Care. 1996; 34: 220-233
        • Warschawski Y.
        • Elbaz A.
        • Segal G.
        • Norman D.
        • Haim A.
        • Jacov E.
        • Grundshtein A.
        • Steinberg E.
        Gait characteristics and quality of life perception of patients following tibial plateau fracture.
        Arch. Orthop. Trauma Surg. 2015; 135: 1541-1546
        • Wasserstein D.
        • Henry P.
        • Paterson J.M.
        • Kreder H.J.
        • Jenkinson R.
        Risk of total knee arthroplasty after operatively treated tibial plateau fracture.
        J. Bone Jt. Surgery-American. 2014; 96: 144-150https://doi.org/10.2106/JBJS.L.01691
        • Weigel D.P.
        • Marsh J.L.
        High-energy fractures of the tibial plateau.
        J. Bone Joint Surg. Am. 84–A. 2002; (Knee function after longer follow-up): 1541-1551
        • Wiss D.A.
        Fractures.
        2nd ed. Lippincott Williams & Wilkins, Philadelphia2006 (.)
        • Yoon R.S.
        • Liporace F.A.
        • Egol K.A.
        Definitive fixation of tibial plateau fractures.
        Orthop. Clin. North Am. 2015; 46: 363-375https://doi.org/10.1016/j.ocl.2015.02.005
        • Zura R.D.
        • Kahn M.D.
        Fractures of the tibial plateau.
        in: Ostrum R.F. Ricci W.M. Orthopaedic Knowledge Update, OKU 5. Trauma. American Academy of Orthopedic Surgeons, Rosemont, IL1996: 159-169