Fracture characteristics and functional outcomes for Schatzker V/VI bicondylar tibial plateau fractures with a separate tubercle fragment: a comparative study

Derek S Stenquist; Tyler D Caton; Eric Y Chen; Faith Selzer; Mitchel B Harris; Marilyn Heng; Michael J Weaver; Arvind G Von Keudell

doi:10.1007/s00402-024-05660-4

Fracture characteristics and functional outcomes for Schatzker V/VI bicondylar tibial plateau fractures with a separate tubercle fragment: a comparative study

Derek S Stenquist^*, Tyler D Caton, Eric Y Chen, Faith Selzer, Mitchel B Harris, Marilyn Heng, Michael J Weaver, Arvind G Von Keudell

^*Corresponding author for this work

Research output: Contribution to journal › Journal article › Research › peer-review

1 Citation (Scopus)

Abstract

INTRODUCTION: A separate tibial tubercle fragment (TF) is found in up to half of all bicondylar tibial plateau (BTP) fractures. Adequate healing of the TF is required to reconstitute the extensor mechanism of the knee. The purpose of this study was to compare outcomes after surgical fixation of BTP fractures with and without a TF.

MATERIALS AND METHODS: Retrospective comparative study of adult patients undergoing open reduction internal fixation (ORIF) of a Schatzker V/VI BTP fracture at two Level 1 trauma centers. Primary outcomes were patient-reported outcomes as assessed by the PROMIS Physical Function (PF) score and EQ-5D-3L. Secondary outcomes included rates of infection, reoperation, and nonunion. Patient demographics, fracture characteristics, and outcomes were compared for patients with and without a TF.

RESULTS: 189 patients (mean follow-up 8.1 yrs) were included. 55 patients (29%) had a separate TF. There was no significant difference in PROMIS PF (48.1 vs 47.5, p = 0.45) or EQ-5D-3L scores (0.82 vs 0.83, p = 0.32) between patients with and without a separate tubercle fragment.Patients with a TF had more open fractures (16% vs 5%, p = 0.02) and high energy injuries (66% vs 49%, p = 0.03).There was no significant difference in the rates of deep infection (15% vs 8%, p = 0.19) or unplanned reoperation (23% vs 13%, p = 0.09). There were more nonunions in the TF group (11% vs 2%, p = 0.02) but only two involved the tubercle fragment.

CONCLUSION: In this comparative study, the presence of a TF did not portend a worse functional outcome for patients with a healed fracture. Rates of open fracture and high energy mechanism of injury were significantly higher in the TF group.. Surgeons should be aware that a separate TF may indicate a more severe injury. More studies are needed to determine whether the presence of a TF is associated with higher complication rates.

Original language	English
Article number	112
Journal	Archives of Orthopaedic and Trauma Surgery
Volume	145
Issue number	1
Number of pages	9
ISSN	0936-8051
DOIs	https://doi.org/10.1007/s00402-024-05660-4
Publication status	Published - 2025
Externally published	Yes

Bibliographical note

Keywords

Humans
Tibial Fractures/surgery
Male
Female
Retrospective Studies
Middle Aged
Adult
Fracture Fixation, Internal/methods
Patient Reported Outcome Measures
Treatment Outcome
Open Fracture Reduction/methods
Aged
Reoperation/statistics & numerical data
Tibial Plateau Fractures

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Stenquist, D. S., Caton, T. D., Chen, E. Y., Selzer, F., Harris, M. B., Heng, M., Weaver, M. J., & Von Keudell, A. G. (2025). Fracture characteristics and functional outcomes for Schatzker V/VI bicondylar tibial plateau fractures with a separate tubercle fragment: a comparative study. Archives of Orthopaedic and Trauma Surgery, 145(1), Article 112. https://doi.org/10.1007/s00402-024-05660-4

Fracture characteristics and functional outcomes for Schatzker V/VI bicondylar tibial plateau fractures with a separate tubercle fragment: a comparative study. / Stenquist, Derek S; Caton, Tyler D; Chen, Eric Y et al.
In: Archives of Orthopaedic and Trauma Surgery, Vol. 145, No. 1, 112, 2025.

Research output: Contribution to journal › Journal article › Research › peer-review

Stenquist, DS, Caton, TD, Chen, EY, Selzer, F, Harris, MB, Heng, M, Weaver, MJ & Von Keudell, AG 2025, 'Fracture characteristics and functional outcomes for Schatzker V/VI bicondylar tibial plateau fractures with a separate tubercle fragment: a comparative study', Archives of Orthopaedic and Trauma Surgery, vol. 145, no. 1, 112. https://doi.org/10.1007/s00402-024-05660-4

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abstract = "INTRODUCTION: A separate tibial tubercle fragment (TF) is found in up to half of all bicondylar tibial plateau (BTP) fractures. Adequate healing of the TF is required to reconstitute the extensor mechanism of the knee. The purpose of this study was to compare outcomes after surgical fixation of BTP fractures with and without a TF.MATERIALS AND METHODS: Retrospective comparative study of adult patients undergoing open reduction internal fixation (ORIF) of a Schatzker V/VI BTP fracture at two Level 1 trauma centers. Primary outcomes were patient-reported outcomes as assessed by the PROMIS Physical Function (PF) score and EQ-5D-3L. Secondary outcomes included rates of infection, reoperation, and nonunion. Patient demographics, fracture characteristics, and outcomes were compared for patients with and without a TF.RESULTS: 189 patients (mean follow-up 8.1 yrs) were included. 55 patients (29%) had a separate TF. There was no significant difference in PROMIS PF (48.1 vs 47.5, p = 0.45) or EQ-5D-3L scores (0.82 vs 0.83, p = 0.32) between patients with and without a separate tubercle fragment.Patients with a TF had more open fractures (16% vs 5%, p = 0.02) and high energy injuries (66% vs 49%, p = 0.03).There was no significant difference in the rates of deep infection (15% vs 8%, p = 0.19) or unplanned reoperation (23% vs 13%, p = 0.09). There were more nonunions in the TF group (11% vs 2%, p = 0.02) but only two involved the tubercle fragment.CONCLUSION: In this comparative study, the presence of a TF did not portend a worse functional outcome for patients with a healed fracture. Rates of open fracture and high energy mechanism of injury were significantly higher in the TF group.. Surgeons should be aware that a separate TF may indicate a more severe injury. More studies are needed to determine whether the presence of a TF is associated with higher complication rates.",

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T1 - Fracture characteristics and functional outcomes for Schatzker V/VI bicondylar tibial plateau fractures with a separate tubercle fragment

T2 - a comparative study

AU - Stenquist, Derek S

AU - Caton, Tyler D

AU - Chen, Eric Y

AU - Selzer, Faith

AU - Harris, Mitchel B

AU - Heng, Marilyn

AU - Weaver, Michael J

AU - Von Keudell, Arvind G

PY - 2025

Y1 - 2025

N2 - INTRODUCTION: A separate tibial tubercle fragment (TF) is found in up to half of all bicondylar tibial plateau (BTP) fractures. Adequate healing of the TF is required to reconstitute the extensor mechanism of the knee. The purpose of this study was to compare outcomes after surgical fixation of BTP fractures with and without a TF.MATERIALS AND METHODS: Retrospective comparative study of adult patients undergoing open reduction internal fixation (ORIF) of a Schatzker V/VI BTP fracture at two Level 1 trauma centers. Primary outcomes were patient-reported outcomes as assessed by the PROMIS Physical Function (PF) score and EQ-5D-3L. Secondary outcomes included rates of infection, reoperation, and nonunion. Patient demographics, fracture characteristics, and outcomes were compared for patients with and without a TF.RESULTS: 189 patients (mean follow-up 8.1 yrs) were included. 55 patients (29%) had a separate TF. There was no significant difference in PROMIS PF (48.1 vs 47.5, p = 0.45) or EQ-5D-3L scores (0.82 vs 0.83, p = 0.32) between patients with and without a separate tubercle fragment.Patients with a TF had more open fractures (16% vs 5%, p = 0.02) and high energy injuries (66% vs 49%, p = 0.03).There was no significant difference in the rates of deep infection (15% vs 8%, p = 0.19) or unplanned reoperation (23% vs 13%, p = 0.09). There were more nonunions in the TF group (11% vs 2%, p = 0.02) but only two involved the tubercle fragment.CONCLUSION: In this comparative study, the presence of a TF did not portend a worse functional outcome for patients with a healed fracture. Rates of open fracture and high energy mechanism of injury were significantly higher in the TF group.. Surgeons should be aware that a separate TF may indicate a more severe injury. More studies are needed to determine whether the presence of a TF is associated with higher complication rates.

AB - INTRODUCTION: A separate tibial tubercle fragment (TF) is found in up to half of all bicondylar tibial plateau (BTP) fractures. Adequate healing of the TF is required to reconstitute the extensor mechanism of the knee. The purpose of this study was to compare outcomes after surgical fixation of BTP fractures with and without a TF.MATERIALS AND METHODS: Retrospective comparative study of adult patients undergoing open reduction internal fixation (ORIF) of a Schatzker V/VI BTP fracture at two Level 1 trauma centers. Primary outcomes were patient-reported outcomes as assessed by the PROMIS Physical Function (PF) score and EQ-5D-3L. Secondary outcomes included rates of infection, reoperation, and nonunion. Patient demographics, fracture characteristics, and outcomes were compared for patients with and without a TF.RESULTS: 189 patients (mean follow-up 8.1 yrs) were included. 55 patients (29%) had a separate TF. There was no significant difference in PROMIS PF (48.1 vs 47.5, p = 0.45) or EQ-5D-3L scores (0.82 vs 0.83, p = 0.32) between patients with and without a separate tubercle fragment.Patients with a TF had more open fractures (16% vs 5%, p = 0.02) and high energy injuries (66% vs 49%, p = 0.03).There was no significant difference in the rates of deep infection (15% vs 8%, p = 0.19) or unplanned reoperation (23% vs 13%, p = 0.09). There were more nonunions in the TF group (11% vs 2%, p = 0.02) but only two involved the tubercle fragment.CONCLUSION: In this comparative study, the presence of a TF did not portend a worse functional outcome for patients with a healed fracture. Rates of open fracture and high energy mechanism of injury were significantly higher in the TF group.. Surgeons should be aware that a separate TF may indicate a more severe injury. More studies are needed to determine whether the presence of a TF is associated with higher complication rates.

KW - Humans

KW - Tibial Fractures/surgery

KW - Male

KW - Female

KW - Retrospective Studies

KW - Middle Aged

KW - Adult

KW - Fracture Fixation, Internal/methods

KW - Patient Reported Outcome Measures

KW - Treatment Outcome

KW - Open Fracture Reduction/methods

KW - Aged

KW - Reoperation/statistics & numerical data

KW - Tibial Plateau Fractures

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DO - 10.1007/s00402-024-05660-4

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C2 - 39774982

SN - 0936-8051

VL - 145

JO - Archives of Orthopaedic and Trauma Surgery

JF - Archives of Orthopaedic and Trauma Surgery

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