Short term outcome of patients with tibial plateau fractures treated at Muhimbili orthopaedic institute 2012

Abstract

Background: The management of tibial plateau fractures continues to be a challenge for orthopedics surgeons. Restoration of articular congruity and early range of motion should be the primary goal of treatment. Proper and adequate preoperative planning is essential for a good outcome. Historically the treatment of these fractures has been plagued by complications despite of better understanding of soft tissues injury and advancement in different treatment modalities.

Objectives: We evaluated the short-term outcome of patients with tibial plateau fractures treated at MOI 2012.

Methodology: A hospital based cross sectional prospective study was done on adult patients with tibial plateau fractures treated at MOI. Seventy four patients met our study inclusion criteria but 5 patients were lost follow up, so we reviewed 69 patients who completed follow ups. A researcher used a structured questionnaire to interview the participants. These patients were treated by either conservative or surgical method. Immediately post operatively control radiographs were taken. Then each patient was followed up for a minimum of 16 weeks post treatment. In the follow up visits, status of the wound, flexion of the knee, ability to bear weight without pain, fracture healing and stability of the knee were assessed. The obtained data were analyzed by SPSS version 21.

Results: Male were affected more than females with male to female ratio 5.9:1. Majority of patients were aged from 29 to 50 years with age range of 19 to 69 and mean age of 39.5 years ± 10.7 SD. Road traffic crash was the most common cause of injury, 79.7%. Patients who were treated conservatively were 42% and those who were treated surgically were 58%. Deep wound infection occurred in 12% among patients who were treated surgically. One patient (16.7%) out of 6 patients with open fractures had infection while 4 patients (11.8%) out of 34 patients with closed fractures had infection. The overall knee flexion of less than 90 degrees was encountered in 37.9% among conservatively treated patients and 25% among surgically treated patients. Severe limitation to weight bearing by pain was encountered in 6.9% of conservatively treated patients and in 5% of surgically treated patients. By 16th week 93.1% of conservatively treated patients had their fracture healed and 95% of surgically treated patients had their fracture healed. Knee instability was encountered in 3.4% in conservatively treated patients and in 5% in surgically treated patients. Time from treatment to full weight bearing between 6 and 12 weeks were encountered in 55.2% of conservatively treated patients and in 32.5% of surgically treated patients. Patients who started full weight bearing after 12 weeks were 44.8% in conservatively treated patients and in 67.5% in surgically treated patients.

Conclusion: Both conservative and surgical methods of treatment are effective in the treatment of tibial plateau fractures depending on the type and severity of the fracture. In this study, good results in terms of knee joint flexion, stability, fracture union and ability to bear weight without pain were seen in both conservatively and surgically treated patients.