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Postoperative joint stepoff
38%
1127/2968
Alteration of limb mechanical axis
57%
1706/2968
Fracture type
3%
79/2968
Male sex
0%
13/2968
Age greater than 50
1%
33/2968
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Maintenance of mechanical axis correlates most with a satisfactory clinical outcome when managing an intra-articular fracture of the proximal tibia. According to the study of plateau fractures with up to 27 year follow-up by Rademakers et al, malalignment of the limb by greater than 5 degrees tripled the rate of degenerative osteoarthritis (27% v. 9%). Age at time of injury had no effect on outcome; 31% had joint space narrowing but 64% of those knees were well tolerated. Weigel and Marsh's study looked at high energy plateau fractures treated with staged external fixation followed by internal fixation, and noted a low rate of severe arthrosis even with mild to moderate joint incongruity. Stevens et al noted a worse outcome with increasing age at presentation with these injuries; fracture type had a small influence and adequacy of reduction had no significant influence on outcome. Figure A is a coronal CT image showing a lateral tibial plateau fracture with significant joint depression.
3.3
(45)
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