Stenquist Derek S, Caton Tyler D, Chen Eric Y, Selzer Faith, Harris Mitchel B, Heng Marilyn, Weaver Michael J, Von Keudell Arvind G
Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA.
Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Building, 55 Fruit Street, Boston, MA, 02114, USA.
Arch Orthop Trauma Surg. 2025 Jan 7;145(1):112. doi: 10.1007/s00402-024-05660-4.
A separate tibial tubercle fragment (TF) is found in up to half of all bicondylar tibial plateau (BTP) fractures. Adequate healing of the TF is required to reconstitute the extensor mechanism of the knee. The purpose of this study was to compare outcomes after surgical fixation of BTP fractures with and without a TF.
Retrospective comparative study of adult patients undergoing open reduction internal fixation (ORIF) of a Schatzker V/VI BTP fracture at two Level 1 trauma centers. Primary outcomes were patient-reported outcomes as assessed by the PROMIS Physical Function (PF) score and EQ-5D-3L. Secondary outcomes included rates of infection, reoperation, and nonunion. Patient demographics, fracture characteristics, and outcomes were compared for patients with and without a TF.
189 patients (mean follow-up 8.1 yrs) were included. 55 patients (29%) had a separate TF. There was no significant difference in PROMIS PF (48.1 vs 47.5, p = 0.45) or EQ-5D-3L scores (0.82 vs 0.83, p = 0.32) between patients with and without a separate tubercle fragment.Patients with a TF had more open fractures (16% vs 5%, p = 0.02) and high energy injuries (66% vs 49%, p = 0.03).There was no significant difference in the rates of deep infection (15% vs 8%, p = 0.19) or unplanned reoperation (23% vs 13%, p = 0.09). There were more nonunions in the TF group (11% vs 2%, p = 0.02) but only two involved the tubercle fragment.
In this comparative study, the presence of a TF did not portend a worse functional outcome for patients with a healed fracture. Rates of open fracture and high energy mechanism of injury were significantly higher in the TF group.. Surgeons should be aware that a separate TF may indicate a more severe injury. More studies are needed to determine whether the presence of a TF is associated with higher complication rates.
在所有双髁胫骨平台（BTP）骨折中，高达半数会出现单独的胫骨结节骨折块（TF）。TF充分愈合对于重建膝关节伸肌机制至关重要。本研究旨在比较有和没有TF的BTP骨折手术固定后的疗效。
对在两个一级创伤中心接受Schatzker V/VI型BTP骨折切开复位内固定（ORIF）的成年患者进行回顾性比较研究。主要结局指标为患者报告结局，通过PROMIS身体功能（PF）评分和EQ-5D-3L进行评估。次要结局指标包括感染率、再次手术率和骨不连率。对有和没有TF的患者的人口统计学特征、骨折特点和结局进行比较。
纳入189例患者（平均随访8.1年）。55例患者（29%）有单独的TF。有和没有单独结节骨折块的患者在PROMIS PF评分（48.1对47.5，p = 0.45）或EQ-5D-3L评分（0.82对0.83，p = 0.32）方面无显著差异。有TF的患者开放性骨折更多（16%对5%，p = 0.02），高能损伤更多（66%对49%，p = 0.03）。深部感染率（15%对8%，p = 0.19）或非计划再次手术率（23%对13%，p = 0.09）无显著差异。TF组骨不连更多（11%对2%，p = 0.02），但只有两例涉及结节骨折块。
在本比较研究中，对于骨折已愈合的患者，TF的存在并不预示功能结局更差。TF组开放性骨折率和高能损伤机制发生率显著更高。外科医生应意识到单独的TF可能提示更严重的损伤。需要更多研究来确定TF的存在是否与更高的并发症发生率相关。
