Parkkinen M, et al. - This study entailed the identification of the factors exerting an impact on the development of posttraumatic osteoarthritis (OA) following medial tibial plateau fractures. Additionally, the authors sought to contemplate the concomitant injuries related to such fractures. It was reported that the amount of articular depression estimated via preoperative CT scans possibly speculated the development of posttraumatic OA. This, in turn, could reflect the severity of the chondral injury at the time of fracture. In order to yield a good clinical outcome, restoration of the mechanical axis and articular congruence served as vital factors.

Methods

• Researchers undertook a chart review of patients with operatively treated medial tibial plateau fractures admitted to the Level I trauma centre from 2002 to 2008.
• Among 63 patients, 41 underwent a clinical and radiographic examination.
• The mean age was 47 years (range 16-78) and the mean follow-up time was 7.6 (range 4.7-11.7) years.
• Preoperative computed tomography (CT) scans and postoperative radiographs were performed on all patients.
• An analysis was conducted of the standing radiographs, mechanical axis, and CT scans, at the end of follow-up.

Results

• Herein among the 41 patients, 24 reported no or mild (Kellgren-Lawrence grade 0-2) OA and 17 presented with severe (grade 3-4) OA.
• Initial articular depression estimated from preoperative CT scans served as a crucial predictor of OA (median 1.8 mm vs 4.5 mm, p=0.009).
• It was noted that the fracture line extension to the lateral plateau (p=0.68) or fracture comminution (p=0.21) did not exert any impact on the development of posttraumatic OA, nor did articular depression at the end of follow-up (p=0.68), as estimated from CT scans.
• A link was brought to light between the mechanical axis >4° of varus and ≥2 mm articular depression or step-off with worse WOMAC pain scores.
• However, it did not influence other functional outcome scores.
• Six patients (10%) reported permanent peroneal nerve dysfunction.
• LCL reconstruction was required in 10 patients (16%) and nine (14%) ACL avulsions were treated at the time of fracture stabilisation.