Determination of outcomes of complex upper end tibial fractures in squatting and cross leg sitting South Asian population.
INTRODUCTION Treatment of complex upper end tibial fractures has always been a challenge to orthopaedic surgeons. Though the roentgenogram results are satisfactory, the clinical and functional outcomes especially in terms of squatting/cross leg sitting after long term follow up are little known. Hence, we have done this study with a primary aim to assess the clinico radiological and functional outcomes after operative fixation (mostly by locking plates) in complex upper end tibial fractures and a secondary aim to analyze correlation between functional outcome scores/range of motion (ROM) and the ability to squat sit cross legged in post operative period. MATERIALS AND METHODS This prospective study included a total of 33 patients who were mainly treated with locking plates. In the follow up, patients were assessed clinico radiologically and outcome measurements were determined using the Tegner Lysholm (T L) Knee Score. Patients were categorized according to their ability to squat/sit cross legged and a subgroup analysis was performed by comparing mean ROM and T L score in each group. RESULTS Majority of patients were in young and adult age group with a male to female ratio of 4.5:1. The average age was 42.39 14.64 years. Road traffic accident was the most common mode of injury. Average time interval between injury and surgery was 5.8+ 4.4 days. All the fractures united by 5 9 months. Mean ROM and T L score at last follow up were 120.94deg+ 13.63deg and 88.12+ 7.24 respectively. Average shortening, varus and valgus deformity were 0.43+ 0.09 cm, 2.12deg+ 0.62deg and 1.06deg+ 0.45deg respectively. 14 patients (42.42% were able to squat and 15 (45.45% were able to sit cross legged postoperatively. Upon subgroup analysis, difference of mean ROM in those who could squat/sit cross legged was found statistically significant (p<=0.05) however the difference in mean functional scores was not significant (p>=0.05) CONCLUSION Complex upper tibial fractures are a difficult entity to deal with. Anatomical locking plates take care of the alignment, articular congruity as well as ligamentous balancing thus giving good mid term outcomes after ORIF/MIPO. However, applicability of the present functional outcome scores in assessing squatting/cross leg sitting remains doubtful. More weightage needs to be given to these activities to evaluate the outcome in South Asian population.
Injury