Clinical Instability of the Knee and Functional Differences Following Tibial Plateau Fractures Versus Distal Femoral Fractures

Background: Fractures of the knee account for about ۶% of all trauma admissions. While its management is mostly focused on fracture treatment, it is not the only factor that defines the final outcome. Objectives: This study aimed to study objective and subjective outcomes after proximal tibial versus distal femoral fractures in terms of knee instability and health-related quality of life. Patients and Methods: This retrospective, cross-sectional, cohort study was carried out on ۸۰ patients with either isolated proximal tibial (n = ۴۲) or distal femoral (n = ۳۸) fractures, who underwent open reduction and internal fixation. All the fractures were classified based on the Schatzker and AO classification for tibial plateau and distal femoral fractures, respectively. The patients were followed and examined by an orthopedic knee surgeon for clinical assessment of knee instability. In their last follow-up visit, these patients completed a Lysholm knee score and the short-form (SF) ۳۶ health survey. Results: Among the ۴۲ tibial plateau fractures, ۲۵% were classified as Schatzker type ۲. Of the ۳۸ distal femoral fractures, we did not find any type B۱ or B۳ fractures. The overall prevalence of anterior and posterior instability was ۴۲% and ۲۰%, respectively. Medial Collateral Ligament (MCL) and Lateral Collateral Ligament (LCL) injuries were detected clinically in ۵۰% and ۲۸%, respectively. The incidence rates of ligament injuries in tibial plateau fractures were as follows: Anterior Collateral Ligament (ACL) ۲۶%, Posterior Collateral Ligament (PCL) ۷%, MCL ۲۴%, and LCL ۱۴%. Medial collateral ligament injury was the most common in the Schatzker type ۲ (۵۰% of the injuries). Distal femoral fractures were associated with ACL injury in ۱۶%, PCL in ۱۳%, MCL in ۲۶% and LCL in ۱۴%. However, final knee range of motion (ROM) and function (Lysholm score) were not associated with fracture location. No statistically significant difference was observed between the two groups, except for the valgus stress test at ۳۰°knee flexion, which was more positive in tibial fractures. All eight domains of SF-۳۶ score in the distal femoral and proximal tibial fractures were significantly different from the normal values; however, there were no statistically significant differences between femoral and tibial fracture scores. Conclusions: Although ROM is acceptable in knee joint fractures, instability is common. However, it seems that knee function and quality of life are not associated with the location of the fracture

کلیدواژه ها:

knee ، Knee Instability ، ACL ، PCL ، Quality of Life