Kitchen David Stuart, Richards Jack, Smitham Peter J, Atkins Gerald J, Solomon Lucian B
Discipline of Orthopaedics and Trauma, Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, SA 5005, Australia.
Orthopaedic and Trauma Service, Royal Adelaide Hospital, Adelaide, SA 5000, Australia.
J Clin Med. 2021 Dec 27;11(1):138. doi: 10.3390/jcm11010138.
Surgical management of displaced tibial plateau fracture (TPF) is often delayed due to accompanying soft tissue injuries sustained at the time of injury. The primary aim of this study was to assess the effect of time to surgery on fracture reduction in cases of TPF. The secondary aim was to assess the effect of preoperative demographics and residual articular step on Lysholm Scores and Knee Injury and Osteoarthritis Outcome Scores (KOOS) following fixation. Patients between 2006 and 2017, managed by a single surgeon, were prospectively enrolled in the study. Reduction of articular step, defined as <2 mm, was assessed by a single blinded examiner. A total of 117 patients were enrolled, 52 with Schatzker II, 4 with Schatzker IV, and 61 with Schatzker VI fractures. Patients were followed up to a mean of 3.9 years. Analysis showed that the ability to achieve fracture reduction was negatively influenced by time to theatre, with the odds of achieving reduction decreasing 17% with each subsequent day post injury ( = 0.002). Furthermore, an increased time to theatre was associated with a reduced Lysholm score at one year ( = 0.01). The ability to achieve fracture reduction did not influence PROMs within the study period. We conclude that delay in surgical fixation negatively affects fracture reduction in TPF and may delay recovery. However, residual articular step does not necessarily influence PROMs over the mid-term.
由于受伤时伴有软组织损伤，移位性胫骨平台骨折（TPF）的手术治疗常常延迟。本研究的主要目的是评估手术时机对TPF病例骨折复位的影响。次要目的是评估术前人口统计学特征和残余关节台阶对固定后Lysholm评分以及膝关节损伤和骨关节炎疗效评分（KOOS）的影响。2006年至2017年间由一名外科医生治疗的患者被前瞻性纳入本研究。由一名单盲检查者评估关节台阶的复位情况，定义为<2mm。共纳入117例患者，其中Schatzker II型52例，Schatzker IV型4例，Schatzker VI型61例。患者平均随访3.9年。分析表明，手术时机对实现骨折复位的能力有负面影响，受伤后每延迟一天，实现复位的几率降低17%（P = 0.002）。此外，手术延迟时间增加与一年时Lysholm评分降低相关（P = 0.01）。在研究期间，实现骨折复位的能力并未影响患者报告结局测量指标（PROMs）。我们得出结论，手术固定延迟会对TPF的骨折复位产生负面影响，并可能延迟恢复。然而，残余关节台阶在中期不一定会影响PROMs。
