Object

Title: Long term results after operative treatment of the proximal tibia fractures

Abstract:

The goal of this thesis was an evaluation of the long term results after operative treatment of the proximal tibial fractures in particular the answers for the following statements:1. What is the functional and radiological long term outcome after open reduction and internal fixation of the proximal tibial fractures depending on the fracture type? 2. If there is an relation between functional and radiological results after this type of treatment?3. What are the most common complications after surgical treatment of the proximal tibial fractures?4. What is the influence of the implant on the functional and radiological results?The materials and methods:65 patients treated in the Department of Orthopedy and Traumatology of the 5. Military Hospital in Cracow were included. There were 42 (64.7%) males and 23 (35,3%) females operated between 2007 to 2010. Their age was between 45 to 68 years, mean 54 years. The inclusion criteria was the proximal tibial fracture treated with open reduction and internal fixation with lag screws and buttress plates. The follow up was 12 to 17 months, mean 15 months. In 45 patients (69,2%) the implants were not removed after bone healing. In this group there were 33 males (50,8%) and 12 females (18,4%). In 20 (30,8%) patients the implants were removed after bone consolidation . There were 9 males (19,9%) and 11 females (16,9%) in this group. In assessment of the fracture type, the Schatzker classification was used. There were 9 patient with fracture type I, 14 with type II, 14 with type III, 10 patients with type IV, 6 with type V and 12 with type VI of ; fracture. The most common cause of the fracture were the motor vehicle accidents – in 29 cases (44,5%), the less common - in 11 (17%) patients – the fall down on the same level or the height less than 1,5. All the patients were treated with open reduction and internal fixation using the lag screws and buttress plates. In 4 (2 males and 2 females) cases the initial knee arthroscopy was performed before the internal fixation. In 8 cases (12,3%) the allogenic bone graft was used in addition to internal fixation.. The final follow up was performed 3 months after implant removal in this group of patients and 6 months after surgery in the group where implants were not removed. For the radiological assessment the Rasmussen [39] classification was used and for the functional one – the HSS scale with Golec and Nowak [40] modification. The complication were evaluated in the postoperative period, 3 months after implant removal in this group of patients and 6 months after internal fixation in the group where implant was not removed. The statistical analysis with Statistica program was performed. Results:Overall analysis based on the HSS scale with Golec and Nowak [40] modification showed the following results in the two groups of patients (group with and with not implant removal) according to the fracture type:Combined analysis of both groups showed the results as follows:- in the type I fracture there were 4 excellent results (6,2%), 3 very good (4,7%), and good in 2 cases (3,1%). The mean point values were 88 points, 81 and 63 for the excellent, very good and good results respectively. - in the type II fractures there were 4 excellent results (6,2%), 5 very good (7,8%), good in 4 cases (6,2%) and in 1 patients – bad result (1,6%). The mean point values were 86 points, 76, 63 and 58 for the excellent, very good, good and bad results respectively. - in the type III fracture there was 1 excellent result (1,6%), 5 very good (7,8%), good in 6 cases (9,4%) and 2 bad result (3,1%). The mean point values were 87 points, 74, 63 and 55 for the excellent, very good, good and bad results respectively. - in the type IV fracture there was 1 excellent result (1,6%), 1 very good (1,6%), good in 5 cases (7,8%) and 3 bad result (4,7%). The mean point values were 87 points, 73, 63 and 55 for the excellent, very good, good and bad results respectively. - in the type V fracture there was only 5 bad results (7,8%) with the mean point values of 55. - in the type VI fracture there was 1 very good result (1,6%), 6 good (9,4%) and 5 bad result (7,8%) with the mean point values of 70 points, 63 and 53 respectively. The biggest numbers of 24 patients showed the good results (37,1%), the smallest number of 10 patients showed the excellent results (15,4%). Excellent and very good results were observed in 25 patients (38,4%). For the radiological assessment the Rasmussen classification was used. Overall analysis based on this scale showed the following results in the two groups of patients (group with and with not ; implant removal) according to the fracture type:Combined analysis of Rasmussen classification in both groups showed the following results:- in the type I fracture there were 6 excellent results (9,4%) and 2 very good (3,1%) with mean point values of 15 and 13 respectively. - in the type II fractures there were 6 excellent results (9,4%), 7 very good (10,8%) and 1 good result (1,6%) . The mean point values were 15 points, 13 and 11 respectively. - in the type III fractures there were 3 excellent results (4,7%), 7 very good (10,8%) and 5 good result (7,8%). The mean point values were 15 points, 13 and 10 respectively. - in the type IV fractures there was 1 excellent result (1,6%), 3 very good (4,7%), 5 good (7,8%) and 1 bad result (1,6%). The mean point values were 15 points, 13, 10 and 7 respectively. - in the type V fracture there was only 6 good results (9,4 %) with the mean point values of 10. - in the type VI fracture there was 1 excellent (1,6%), 4 very good (6,2%) 4 good (6,2%) and 3 bad result (4,7 %) with the mean point values of 15, 13,13 and 7 respectively. The biggest numbers of 22 patients showed the good results (33,8%), the smallest number of 5 patients showed the bad results (7,7%). Excellent and very good results were observed in 39 patients ( 60%). The analysis of the early and late complications was reported in the patients group. The early complications were observed in 7 patients (10,5%) with the fracture of type II, IV,V and VI. The most common complication seen in 2 (3%) patient was the superficial infection. The most serious late complication was the presence of big scar on the anterior-medial aspect of the proximal tibia seen in 1 patient (1,5%). It was seen in the patient with very early post operative skin necrosis where the skin excision was performed. Statistical analysis:1. In statistical analysis characteristic variables, arithmetic mean, minimum value, maximum value, median value and standard deviation were used.2. Evaluation of variance verifying differences between tested groups.3. The relationship between the ratios tested by test χ².4. The relationship between the ratios tested by nonparametric tests Mann-Whitney and Wilcoxon.There was no statistical difference in both groups and sex in radiological and functional outcome. The significance level p close to 0 was observed only in the correlation between type of fracture and the radiological and functional outcome. In types I, II, III functional results are worse than radiological, but in types IV, V, VI functional results are much more worse than radiological.According to the results, the following final statements can be proposed: 1. The final outcome of the proximal tibial fractures treated with open reduction and internal fixation showed the excellent and very good radiological and good and bad functional results. ; 2. There is no correlation between the radiological and functional outcome in the surgical treatment of the proximal tibial fractures.3. The most common complications in the treatment of the proximal tibial fractures are the superficial infections.4. The presence of metallic implants binding together the proximal tibia fractures of type I, II and III in follow-up results in very good and good radiological and functional outcomes. However in case of IV, V and VI types, removing metallic implants slightly worsens radiological and significantly functional results.

Place of publishing:

Kraków

Level of degree:

2 - studia doktoranckie

Degree discipline:

ortopedia

Degree grantor:

Wydział Lekarski Uniwersytetu Jagiellońskiego. Collegium Medium.

Promoter:

Edward Bogusław Golec

Date issued:

2011

Format:

application/pdf

Identifier:

oai:dl.cm-uj.krakow.pl:3406

Call number:

ZB-116235

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Language:

pol

Access rights:

nieograniczony

Location of original object:

Biblioteka Medyczna Uniwersytetu Jagiellońskiego- Collegium Medicum

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Last modified:

Oct 17, 2019

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Mar 5, 2013

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