Early Functional Outcomes Of Closed Tibial Plateau Fractures In A Kenyan Setting

Abstract

BACKGROUND: Tibial plateau fractures result from compressive axial forces alone, or combined with varus or valgus stresses on the knee and may interfere with the functional integrity of the joint. These fractures can be managed non-operatively or surgically, based on the availability of resources and magnitude of the injury. Functional outcomes of these fractures is based on the complexity of the injury and the type of treatment provided. The purpose of this study is to determine the early functional outcome of tibial plateau fractures and correlate it with severity of injury and treatment in a Kenyan setting. OBJECTIVES: To describe the pattern and early functional outcome of closed tibial plateau fractures at Kenyatta National and PCEA Kikuyu hospitals. STUDY POPULATION: Forty-four adult patients diagnosed with tibial plateau fractures in Orthopaedic wards and clinics of PCEA Kikuyu and Kenyatta National Hospitals. STUDY DESIGN: Descriptive Cross-sectional Study MATERIALS AND METHODS: A sample of 44 adult patients diagnosed with tibial plateau fractures at PCEA Kikuyu and Kenyatta National Hospitals were recruited in the current study by convenient sampling. Patient demographic characteristics including age and gender were recorded. Details on the cause and mechanism of injury were documented. The patients’ primary and secondary injuries were clinically assessed and documented. The post injury radiographs were used to classify the fractures according to the Schatzker classification system. The patients were thereafter managed according to the individual hospital’s protocol. After treatment, the patients were reassessed on the third day, 2nd week, 6 weeks and 3 months for wound healing. The patient’s functional status at 3 months after treatment was determined xiv using the modified Rasmussen’s clinical-radiological criteria. All the collected data were recorded in sheets for analysis. DATA MANAGEMENT: Data were coded and entered into SPSS version 25 for Windows®. Means and standard deviation were determined for the qualitative and quantitative variables. The ANOVA test was used to compare functional outcomes scores in the different fracture groups, and A P value of ≤ 0.05 was considered significant at 95% confidence interval. RESULTS: The male female ratio was 5: 1. The mean age of the participants was 37±11 with age range of 18 to 55 yrs. Soft tissue injuries at presentation ranged from soft tissue edema (n= 34), meniscal tears (n=5), blisters (4), bruises (n=4), compartment syndrome (n=2), lateral collateral ligament tear (n=2). The initial management of all the patients was similar, and it included analgesics and a back-slab support. Thereafter a temporary spanning external fixation device was used in five cases. Definitive management was either non-operative (n= 11; 25%) or surgical (n=33; 75%). Plates were used in 30 patients while one had multiple screws. One patient was managed using a spanning external fixator. The modified Rasmussen Clinical outcome Scores were reported as excellent, good, fair and poor in 5, 14, 1 and 24 patients respectively at twelve weeks after care. Modified Rasmussen radiological outcome Scores were recorded as excellent, good, fair, poor in 22, 12, 6, 4 patients respectively. The mean VAS pain score at twelve weeks was 4±2. CONCLUSIONS: Traumatic tibial Plateau fractures are common in the young males in our setting. These fractures are predominantly managed surgically with excellent radiological outcomes. The early functional outcomes of care of these patients is poor. Longer follow up period is recommended to fully assess the clinical outcomes of care of patients with tibial plateau fractures.