Patient-reported outcomes after tibial plateau fracture: infection confers greatest risk of poor outcome

Introduction: Limited patient-reported outcome measurement (PROM) data exist in peri-articular trauma populations. The purpose of this study was to characterize functional mid-term PROMs and to determine relevant predictors of final PROMs and return to work following tibial plateau fracture.

Methods: Patients with a tibial plateau fracture were identified by Current Procedural Terminology (CPT) codes 27535 and 27536. Retrospective chart review was performed to verify diagnosis and collect relevant demographic and perioperative data. PROMIS PF, KOOS Activities of Daily Living (KOOS ADL), PROMIS Preference (PROPr) scores, and return to work were compared between groups. Multivariate regression was used to determine predictors of PROMs and return to work.

Results: Two hundred and seven patients had minimum 10-month follow-up (67.9% response rate). There were 114 unicondylar and 93 bicondylar injuries. Twenty patients (9.7%) had a post-operative infection. Body mass index (BMI) (B = -0.22; p = 0.021) and post-operative infection (B = -4.3; p = 0.047) were independent predictors of PROMIS-PF. BMI (B = -0.52, p = 0.008), the presence of an ipsilateral lower extremity injury (B = 10.47, p = 0.038), diabetes (B = -10.60; 0.038), and post-operative infection (B = -10.88; p = 0.014) were independent predictors of KOOS ADL. Final PROMIS-PF, KOOS ADL, and post-operative infection were independent predictors of return to work. In a subgroup analysis, infection was associated with markedly lower rate of return to work (39% vs 81%, p = 0.001), PROMIS-PF score (39.8.4 ± 8.6 vs 46.7 ± 8.6; p = 0.002), KOOS ADL score (67.3 ± 25.3 vs 84.6 ± 17.5; p = 0.003), and PROPr score (0.33 ± 0.30 vs 0.52 ± 0.20; p = 0.003).

Conclusion: After operative treatment of tibial plateau fractures, post-operative infection results in large decreases in PROMs and rates of return to work that persist at mid-term follow-up. Future studies should focus on infection prevention strategies in the tibial plateau fracture population.

Level of evidence: III.