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. 2022 Apr;48(2):1479-1486.
doi: 10.1007/s00068-021-01644-w. Epub 2021 Mar 15.

Patients with complex proximal tibial fractures overestimate the prognosis of their injury

Lena Keppler  1 , Alexander Martin Keppler  2 , Christoph Ihle  3 , Philipp Minzlaff  4   5 , Julian Fürmetz  6 , Markus Beck  1 , Tim Saier  1
Affiliations

Patients with complex proximal tibial fractures overestimate the prognosis of their injury

Lena Keppler et al. Eur J Trauma Emerg Surg. 2022 Apr.

Abstract

Purpose: To investigate, if patients with complex proximal tibial fracture have realistic expectations on open reduction and internal fixation.

Methods: 114 patients (mean 49 years, SD ± 13) with closed AO-type B and C proximal tibial fracture were grouped (group B, respectively C). Prior to surgery expectations concerning knee function, pain, return to work/sports, and the risk for osteoarthritis was assessed with the Hospital for Special Surgery-Knee Surgery Expectations Survey (HFSS-KSE) and a non-validated ten-item survey.

Results: 92% of patients expected at least an almost natural knee postoperatively. All items regarding restoring knee function were ranked to be at least important in both groups. 65% in group B and 47% in group C expected at most occasional pain. 83% in group B and 67% in group C expected full return to work without any limitations. Patients with low physical work intensity expected significantly shorter incapacity to work in both groups (7.8, respectively 8.9 weeks). 71% in group B and 60% in group C expected to return to sports with at most small limitations. 33% in group B and 22% in group C assumed risk for osteoarthritis will be prevented by surgery.

Conclusion: Expectations on surgery for complex proximal tibial fracture are high regardless of fracture type. The prognosis of many health and lifestyle domains was overestimated. The risk for osteoarthritis was underestimated. This study should sensitize surgeons to discuss realistic expectations. This may help to improve patient comprehension what leads to sensible expectations, resulting in improved patients´ satisfaction.

Level of evidence: IV.

Trial registration number: 14104, Date of registration: 06/2015.

Keywords: Expectation; Knee function; Osteosynthesis; Return-to-sports; Return-to-work; Tibial fracture.

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Conflict of interest statement

All authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Expectation of duration of incapacity to work (weeks) after osteosynthesis in complex proximal tibial fracture
Fig. 2
Fig. 2
Expectations of comparing the injured knee to a healthy knee
See this image and copyright information in PMC

Comment in

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