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Functional and Clinical Outcomes of Nonsurgically Managed Tibial Plateau Fractures

Pean, Christian A. MD, MS; Driesman, Adam BA; Christiano, Anthony MD; Konda, Sanjit R. MD; Davidovitch, Roy MD; Egol, Kenneth A. MD

Journal of the American Academy of Orthopaedic Surgeons: May 2017 - Volume 25 - Issue 5 - p 375–380
doi: 10.5435/JAAOS-D-16-00217
Research Article

Introduction: This study sought to assess and compare long-term functional and clinical outcomes in patients with tibial plateau fractures that are treated nonsurgically.

Methods: Over a period of 8 years, 305 consecutive tibial plateau fractures were treated by three surgeons at a single institution and followed prospectively in an Institutional Review Board–approved study. Overall, 41 patients (13%) were treated nonsurgically and 37 were available for follow-up. Indications for nonsurgical management were minimal fracture displacement or preclusion of surgery because of comorbidities. A series of univariate retrospective analyses were used to identify individual risk factors potentially predictive of Short Musculoskeletal Functional Assessment scores.

Results: Thirty-seven patients were included with a mean follow-up of 21 ± 14.9 months. Overall, 59% of patients (n = 22) attained good to excellent functional outcomes. In patients for whom surgery was precluded because of comorbidities, outcome scores were significantly poorer (38.8 ± 23.0 versus 12.7 ± 14.2; P = 0.001). Surgery precluded by a factor other than minimal fracture displacement predicted poor outcome (P = 0.002).

Discussion: Carefully selected patients with minimally displaced tibial plateau fractures can expect good to excellent outcomes when treated nonsurgically.

Level of Evidence: Level III, retrospective comparative study

From the Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY.

Correspondence to Dr. Egol: kenneth.egol@nyumc.org.

Dr. Davidovitch or an immediate family member serves as a paid consultant to Pacira and Stryker. Dr. Egol or an immediate family member has received royalties from Exactech; serves as a paid consultant to Exactech and KCI; has received research or institutional support from OMeGA Medical Grants Association, the Orthopaedic Research and Education Foundation, and DePuy Synthes; and serves as a board member, owner, officer, or committee member of the Orthopaedic Trauma Association. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Pean, Mr. Driesman, Dr. Christiano, and Dr. Konda.

Received March 18, 2016

Received in revised form July 25, 2016

Accepted December 01, 2016

© 2017 by American Academy of Orthopaedic Surgeons
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