gms | German Medical Science

Objectives: Surgical treatment of proximal tibial fractures is often associated with complications and postoperative limitations in knee motion. Unrealistic patient expectations of the operation may lead to dissatisfaction with the surgical outcome despite successful surgery. In a previous study it was shown that patients have unrealistic high expectations of surgical intervention in terms of return to work and to sports and pain relief. In this follow-up study fullfillment of these expectations was evaluated.

Methods: In total n=114 patients with complex proximal tibial fracture type AO/OTA-B and C were prospectively enrolled at three level A trauma centers betweeen 2017-2018. Prior to surgery, expectations regarding return to sports and work were assessed. 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 vs. 8.9 weeks). 71% in group B and 60% in group C expected to return to sports with at most small limitations.

This follow-up study confronted every single patient with their individual expectations and fulfillment was graded 0-5 points (highest). Pain was measured with NRS (0-10). Workload was measured according REFA classification (0-4). Follow-up was completed by 49 patients up to now. (n=22m, n=27f, n= 22 AO-B, n=27 AO-C). P<0.05 was assumed as being statistically significant.

Results and conclusion: In total 38 patients of this study cohort were employed, and 46 patients were active in sports. In group B, the mean duration of incapacity to work was 32 weeks vs. 29 weeks (group C). For patients with no or low physical workload (0-2) duration of incapacity to work was 19 weeks (mean) vs. 34 weeks for grade 3-4. No significant correlation between duration of incapacity to work and physical workload could be demonstrated. In group with no or low physical workload, a mean score of 2.5 was found for return to initial work. This corresponds to "No normal return to work but good improvement" and "A moderate improvement" respectively. Similar results were shown in the group with higher workload. Evaluation for return to sports showed 2.8 points in patients in non-professional sports. NRS at rest was 1.3 (no/low physical workload) vs. 1.5 (mild/high physical workload) and pain during physical exercise was 3.1 vs. 3.2 (p>0.05). 77% of the patients in the study cohort were at least "satisfied", or "very satisfied" with the overall results of their surgery. Workload, AO/OTA, age and gender did not influence these results.

This study showed that many patients have unrealistically high preoperative expectations of surgical stabilization of proximal tibial fractures in terms of return to work/sports and pain relief. Although they are therefore not very satisfied with these parameters postoperatively, most of them are satisfied with the overall outcome of the surgery. These findings give us surgeons essential feedback on patient outcome and their focus.