The effect of joint step and plateau widening on clinical and functional outcomes in surgically treated tibial plateau fractures

Introduction: Tibial plateau fractures constitute 1% of all fractures. The management and treatment of these fractures involving the knee joint are specific and difficult. The aim of the treatment is to achieve a stable, joint line preserved, well-aligned, painless knee joint with full function in the long term. There is still no clear consensus on the indications for surgical treatment and rehabilitation protocols. In our study, it was aimed to assist in determining the goals intended with surgery in patients scheduled for surgical treatment. Materials and Methods: The study was conducted with 37 patients who met the inclusion criteria among the cases who underwent surgical treatment for tibial plateau fracture in our clinic between 2013-2022. The descriptive characteristics of the cases were questioned and noted. Radiological imaging and physical examination findings of the patients at preoperative and last controls were scored. The results were analyzed with statistical studies performed with the obtained data. Findings: Of the 37 patients included in our study, 26 (70.3%) were male and 11 (29.7%) were female. The ages of the patients ranged from 23 to 68, with an average of 51.73. Fracture developed as a result of low-energy trauma in 18 patients (48.6%) and high-energy trauma in 19 patients (51.4%). The mean follow-up period of the cases was 42.32 months. The amount of step-off in the operated tibial plateau was found to be 2.32 ± 2.95 mm on average, and the plateau widening was 2.27 ± 2.64 mm on average. The quadriceps muscle strength on the operated side was measured to be 13.32% lower on average compared to the healthy side. The average scores obtained from the scorings were; 83.22 (60–100) in KSKS, 85.14 (40–100) in KSFS, 25.35 (18–30) in RKS, and 14.16 (8–18) in RRS. Conclusions: In tibial plateau fractures, anatomical reduction is associated with excellent clinical, functional, and radiological results. In addition, effective rehabilitation of the patients makes significant contributions to the surgical treatment performed. Poor quadriceps muscle strength and extensor mechanism adversely affect clinical and radiological outcomes. Finally, there is no significant relationship between trauma energy levels and postoperative anatomical axis and MPTA values in operated patients. However, we found a significant and strong correlation between the postoperative MPTA and anatomical axis measurements of the cases. This result shows that the restoration of the joint surface and correction of the MPTA play a key role in achieving anatomical alignment, which is one of the goals of surgical treatment.