Tibial plateau fractures in elderly associated with significant deterioration in health-related QoL

In older patients severe patterns of injury can occur even in low energy falls such as from standing height. As such, TPFs in older adults typically fall into the National Institute for Health and Care Excellence (NICE) definition of complex fractures which includes “joints broken into multiple.”

S. Gupta et al undertook a retrospective, case-control study of 67 patients at mean 3.5 years after TPF (47 patients underwent fixation, and 20 nonoperative management).The study was conducted at ‘Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.’

Patients completed EuroQol five-dimension three-level (EQ-5D-3L) questionnaire, Lower Limb Function Scale (LEFS), and Oxford Knee Scores (OKS) for current and recalled prefracture status. Propensity score matching for age, sex, and deprivation in a1:5 ratio was performed using patient level data from the Health Survey for England to obtain a control group for HRQoL comparison. The primary outcome was the difference in actual (TPF cohort) and expected (matched control) EQ-5D-3L score after TPF.

Key findings of the study were:

• TPF patients had a significantly worse EQ-5D-3L utility (mean difference (MD) 0.09, 95% confidence interval (CI) 0.00 to 0.16; p < 0.001) following their injury compared to matched controls, and had a significant deterioration (MD 0.140, 95% CI 0 to 0.309; p < 0.001) relative to their preoperative status.

• TPF patients had significantly greater pre-fracture EQ-5D-3L scores compared to controls (p = 0.003), specifically in mobility and pain/discomfort domains.

• A decline in EQ-5D-3L greater than the minimal important change of 0.105 was present in 36/67 TPF patients (53.7%).

• Following TPF, OKS (MD -7; interquartile range (IQR) -1 to -15) and LEFS (MD -10; IQR -2 to -26) declined significantly (p < 0.001) from pre-fracture levels.

• Of the 12 elements of fracture care assessed, the most important to patients were getting back to their own home, having a stable knee, and returning to normal function.

The authors concluded that – “TPFs in older adults were associated with a clinically significant deterioration in HRQoL compared to preinjury level and age, sex, and deprivation matched controls for both undisplaced fractures managed nonoperatively and displaced or unstable fractures managed with internal fixation.”

Further reading:

Tibial plateau fractures in older adults are associated with a clinically significant deterioration in health-related quality of life A PROPENSITY SCORE-MATCHED STUDY

S. Gupta, L. Z. Yapp, D. Sadczuk et al

Bone Jt Open 2023;4-4:273–282.

doi: 10.1302/2633-1462.44.BJO 2023-0022.R