Department of Trauma Surgery, University of Groningen, University Medical Center HPC BA13, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
3D Lab, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Eur J Trauma Emerg Surg. 2023 Apr;49(2):867-874. doi: 10.1007/s00068-022-02139-y. Epub 2022 Oct 20.
Currently used classification systems and measurement methods are insufficient to assess fracture displacement. In this study, a novel 3D measure for fracture displacement is introduced and associated with risk on conversion to total knee arthroplasty (TKA).
A multicenter cross-sectional study was performed including 997 patients treated for a tibial plateau fracture between 2003 and 2018. All patients were contacted for follow-up and 534 (54%) responded. For all patients, the 3D gap area was determined in order to quantify the degree of initial fracture displacement. A cut-off value was determined using ROC curves. Multivariate analysis was performed to assess the association of 3D gap area with conversion to TKA. Subgroups with increasing levels of 3D gap area were identified, and Kaplan-Meier survival curves were plotted to assess survivorship of the knee free from conversion to TKA.
A total of 58 (11%) patients underwent conversation to TKA. An initial 3D gap area ≥ 550 mm was independently associated with conversion to TKA (HR 8.4; p = 0.001). Four prognostic groups with different ranges of the 3D gap area were identified: excellent (0-150 mm), good (151-550 mm), moderate (551-1000 mm), and poor (> 1000 mm). Native knee survival at 10-years follow-up was 96%, 95%, 76%, and 59%, respectively, in the excellent, good, moderate, and poor group.
A novel 3D measurement method was developed to quantify initial fracture displacement of tibial plateau fractures. 3D fracture assessment adds to current classification methods, identifies patients at risk for conversion to TKA at follow-up, and could be used for patient counselling about prognosis.
Prognostic Level III.
目前使用的分类系统和测量方法不足以评估骨折移位。本研究引入了一种新的三维测量方法来评估骨折位移，并与向全膝关节置换（TKA）转化的风险相关联。
进行了一项多中心横断面研究，纳入了 2003 年至 2018 年间治疗的 997 例胫骨平台骨折患者。所有患者均被联系进行随访，其中 534 例（54%）作出回应。对所有患者均确定了三维间隙面积，以量化初始骨折移位的程度。使用 ROC 曲线确定截断值。进行多变量分析以评估三维间隙面积与向 TKA 转化的相关性。确定了三维间隙面积递增的亚组，并绘制 Kaplan-Meier 生存曲线以评估免于 TKA 转化的膝关节的生存率。
共有 58 例（11%）患者行 TKA 转换。初始三维间隙面积≥550mm 与向 TKA 转换独立相关（HR 8.4；p=0.001）。确定了四个具有不同三维间隙面积范围的预后组：优（0-150mm）、良（151-550mm）、中（551-1000mm）和差（>1000mm）。在 10 年随访时，优、良、中、差组的自然膝关节生存率分别为 96%、95%、76%和 59%。
本研究开发了一种新的三维测量方法来量化胫骨平台骨折的初始骨折移位。3D 骨折评估补充了目前的分类方法，确定了随访中向 TKA 转化的风险患者，可用于患者预后咨询。
预后 III 级。
