Evaluación funcional, clínica y radiológica en pacientes operados de fractura de meseta tibial

Abstract

Introduction:
Tibial plateau fractures are complex intra-articular injuries involving the proximal tibial articular surface and may significantly affect knee stability and function. Although they account for only 1–2% of all fractures, they are clinically relevant because of the risk of functional impairment and post-traumatic osteoarthritis. Traditionally, treatment outcomes have been assessed using radiographic parameters; however, these do not always correlate with patient function and quality of life. Therefore, functional outcome measures should complement radiographic evaluation.

Objective:
To evaluate the functional, clinical, and radiographic outcomes of patients surgically treated for tibial plateau fractures and to determine the influence of fracture severity on functional recovery.

Materials and Methods:
A prospective study was conducted on patients who underwent surgical treatment for tibial plateau fractures at the National Institute of Rehabilitation between March 2017 and June 2025. Patients aged 18 to 75 years with a minimum follow-up of 12 months were included. Fractures were classified according to the Schatzker classification and grouped as simple fractures (types I–III) or complex fractures (types IV–VI). Functional outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Rasmussen Clinical Score, and the Short Form-36 (SF-36). Radiographic outcomes were evaluated using the Rasmussen Radiological Score.

Results:
A total of 109 patients were included, of whom 63 (57.8%) were male and 46 (42.2%) were female. Mean age was 41.6 ± 12.9 years, with a mean follow-up of 13.4 ± 7 months. Complex fractures accounted for 60.6% of cases. The overall mean KOOS score was 75.1 ± 14.4 points. Mean SF-36 scores were 75.6 ± 18.6 for the physical component and 82.5 ± 19.5 for the social component. No significant differences were found between simple and complex fractures regarding KOOS scores (76.6 vs. 74.2; p=0.357) or the physical component of the SF-36 (78.3 vs. 74.2; p=0.221). According to the Rasmussen Clinical Score, 44% of patients achieved good or excellent outcomes, with no significant association between fracture severity and functional results (p=0.666). A moderate negative correlation was observed between age and KOOS score (r=-0.32; p=0.044), while a strong positive correlation was found between KOOS and the physical component of the SF-36 (r=0.77; p<0.001).

Conclusions:
Patients surgically treated for tibial plateau fractures demonstrated favorable functional and quality-of-life outcomes at one year of follow-up. Fracture severity according to the Schatzker classification was not associated with worse functional outcomes. Age showed a greater influence on recovery than initial fracture complexity. These findings support the integration of clinical, functional, and radiographic assessments when evaluating treatment outcomes in tibial plateau fractures.