Functional outcomes of proximal tibial fractures treated by open reduction and internal fixation: A hospital based prospective study

Abstract

Objectives: The primary objective of the present study was to determine the functional outcome (using modified Rasmussen clinical scores) of proximal tibial fractures treated by open reduction and internal fixation (ORIF) using three column concept with a minimum follow up period of six months. We also determined the complications of proximal tibial fracture fixation. Methods: This was a prospective study conducted among patients (15-60 years of age, of both gender) with proximal tibia fractures treated using three column concept conducted in the Department of Orthopaedics of a tertiary healthcare hospital in south India between March 2018 and February 2020. Results: The present study included a total of 60 patients with a mean (SD) age of 38.72 years (3.21). The proportion of males and females were 81.7% and 18.3% respectively. Road traffic accidents (RTA) were the most common mode of injury, followed by accidental fall from height (13.3%). Nearly one in four patients (23.3%) had one column involvement, 46.7% had two and 30.0% had three column involvement. In the present study, 6.7% patients had screw pullout, 10.0% had knee stiffness, and 10.0% had wound site infection. The mean (SD) duration of follow up was 12.5 months. Based on Rasmussen’s clinical scores, 20.0% patients had excellent, 63.3% had good, and 16.7% had fair scores. Importantly, none of the patients included in the present study had poor scores. The patients with one column involvement had good to excellent outcomes, in comparison with patients having two or three column involvement having fair outcomes (reduced scores) (p<0.05). Conclusion: Patients with one-column involvement (either medial or lateral) tended to achieve better functional outcomes than those with two or three columns involved. This distinction was statistically significant, emphasizing the impact of fracture complexity on patient recovery.