Bone metabolism is a key factor for clinical outcome of tibial plateau fractures
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ORIGINAL ARTICLE
Bone metabolism is a key factor for clinical outcome of tibial plateau fractures Matthias Krause1 · Lena Alm2 · Markus Berninger1 · Christoph Domnick3 · Kai Fehske4 · Karl‑Heinz Frosch1 · Elmar Herbst3 · Alexander Korthaus1 · Michael Raschke3 · Reinhard Hoffmann5 · The “Fracture committee” of the German Knee Society Received: 24 May 2020 / Accepted: 28 October 2020 © The Author(s) 2020
Abstract 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 patientrelated 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. Keywords Tibial plateau fracture · Bone metabolism · Ten-segment classification · Follow-up · Failure analysis
Introduction
* Matthias Krause [email protected] 1
Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martini Str. 52, 20246 Hamburg, Germany
2
BG Trauma Hospital Hamburg, Hamburg, Germany
3
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
4
Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Würzburg, Germany
5
Department of Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt Am Main, Frankfurt am Main, Germany
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 [1]. There are numerous approach concepts to improve surgical outcome of TPF, including the updated three-column, the revised threecolumn, which is a mechanism-driven approach, and the ten-segment concept [1–5]. Nonetheless, p
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