Department of Orthopaedic Surgery, University of Utah Health, Salt Lake City, UT, USA.
Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Foot Ankle Int. 2022 Oct;43(10):1261-1268. doi: 10.1177/10711007221112924. Epub 2022 Jul 22.
Limited research exists about high performance postsurgical tibial plafond fractures. This study aimed to identify aspects of the plafond fracture injury and care associated with "high performance" based on Patient Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) scores.
Tibial plafond fracture patients with minimum 12-month follow-up treated at a level 1 trauma center from 2006 to 2019 were categorized into high (top 25%) vs average-low (AL) (bottom 75%) performers based on PROMIS PF scores. Demographics and fracture characteristics of high and AL performers were compared. Variables with a value less than .1 were used in stepwise logistic regressions.
The final cohort of 198 patients was divided into high (n=51) and AL (n=147) performers based on PF scores. The mean PF scores for the high and AL groups were 58 (SD=5.3) and 41.9 (SD=6.5), respectively. The mean PROMIS Pain Interference scores for the high performers and AL were 43.3 (SD=4.9) and 56.8 (SD=8.6) ( < .001), respectively. FAAM activities of daily living (high 95.4 [SD=5.5] vs AL 70.4 [SD=19.8], < .001) and FAAM sports (high 76.8 [SD=21.3] vs AL 27.3 [SD=28.9], < .001) subscale scores were significantly greater in the high-performing group. Sex, age, marital status, and diabetes were nonsignificant factors in univariate analysis. Significant demographic factors associated with high performance from univariate analysis were Caucasian race, private insurance, no tobacco use, lower body mass index (BMI), and mechanism of injury. Patients with fracture characteristics of OTA 43C (complete articular) fractures, bone loss, open fractures, or nonexcellent reduction were significantly less likely to be high performers. Additionally, less than excellent reductions were more common in more complex fracture patterns. Multivariable regression modeling showed that higher BMI, OTA/AO 43-C (complete articular) fracture classification, and open fracture were significant independent risk factors for reducing likelihood of high performance.
Significant independent factors associated with high performance after tibial plafond fracture are lower BMI, closed fracture, and OTA/AO 43-B (partial articular) fracture.
关于高性能术后胫骨平台骨折的研究有限。本研究旨在根据患者报告的结局测量信息系统（PROMIS）身体机能（PF）评分，确定与“高性能”相关的平台骨折损伤和护理方面的情况。
2006 年至 2019 年，在一家 1 级创伤中心接受治疗且随访时间至少 12 个月的胫骨平台骨折患者，根据 PROMIS PF 评分分为高（前 25%）和低（AL）（后 75%）表现者。比较高和 AL 表现者的人口统计学和骨折特征。使用 值小于.1 的变量进行逐步逻辑回归。
根据 PF 评分，最终的 198 例患者队列分为高（n=51）和 AL（n=147）表现者。高组和 AL 组的平均 PF 评分分别为 58（SD=5.3）和 41.9（SD=6.5）。高组和 AL 组的 PROMIS 疼痛干扰评分分别为 43.3（SD=4.9）和 56.8（SD=8.6）（ <.001）。FAAM 日常生活活动（高组 95.4[SD=5.5] vs AL 组 70.4[SD=19.8]， <.001）和 FAAM 运动（高组 76.8[SD=21.3] vs AL 组 27.3[SD=28.9]， <.001）亚量表评分在高表现组中显著更高。在单变量分析中，性别、年龄、婚姻状况和糖尿病不是显著因素。单变量分析中与高性能相关的显著人口统计学因素是白种人、私人保险、不吸烟、较低的体重指数（BMI）和损伤机制。OTA 43C（完全关节）骨折、骨丢失、开放性骨折或复位不良的患者发生高性能的可能性显著较低。此外，在更复杂的骨折模式中，复位不良更为常见。多变量回归模型显示，较高的 BMI、OTA/AO 43-C（完全关节）骨折分类和开放性骨折是降低高性能可能性的显著独立危险因素。
胫骨平台骨折后高性能的显著独立因素是较低的 BMI、闭合性骨折和 OTA/AO 43-B（部分关节）骨折。
