gms | German Medical Science

German Congress of Orthopaedics and Traumatology (DKOU 2022)

25. - 28.10.2022, Berlin

Fulfillment of patients’ expectations for osteosynthesis in complex proximal tibial fractures

Meeting Abstract

  • presenting/speaker Lena Keppler - Berufsgenossenschaftliche Unfallklinik Murnau, Unfallchirurgie, Murnau, Germany
  • Fanny Navarre - Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
  • Alexander Martin Keppler - Muskuloskelettales Universitätszentrum München, LMU Klinikum, München, Germany
  • Christoph Ihle - Berufsgenossenschaftliche Unfallklinik Tübingen, Klinik für Unfall- und Wiederherstellungschirurgie, Eberhard Karls Universität Tübingen, Tübingen, Germany
  • Julian Fürmetz - Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
  • Fabian Stuby - Berufsgenossenschaftliche Unfallklinik Murnau, Unfallchirurgie, Murnau, Germany
  • Tim Saier - Berufsgenossenschaftliche Unfallklinik Murnau, Unfallchirurgie, Murnau, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2022). Berlin, 25.-28.10.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocAB24-975

doi: 10.3205/22dkou123, urn:nbn:de:0183-22dkou1234

Published: October 25, 2022

© 2022 Keppler et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

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 mobility and full range of motion of the knee joint. In this follow-up study fulfillment of these expectations was evaluated.

Methods: From 2017-2018, n=114 patients with complex proximal tibial fracture type AO/OTA-B and C were prospectively enrolled at three level A trauma centers. Prior to surgery, expectations were assessed with the Hospital for Special Surgery-Knee Surgery Expectations Score (HSS-KSE) and a 10-item survey regarding return to sports/work/pain relief. These surveys showed high expectations regarding the different parameters. In a follow-up study regarding fulfillment of these expectations every single patient was confronted with their individual expectations (ranged 0=Expectation was not fulfilled up to 2= Expectation was completely fullfilled). This 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: Regarding fulfillment of HSS parameters in most patients at least "partial fulfillment" was reached. HSS parameters reached 1.16- 1.78 points (mean). The parameter "kneeling" performed worst in both groups. The parameter "psychological well-being" performed best. 31 patients (63%) reported that they would rate their operated knee as "A completely normal knee joint with complete improvement" or "An almost normal knee joint with good improvement". 77% of the patients were at least satisfied with the results of their surgery and 71% were at least satisfied if they had to live for the rest of their life with exactly the knee joint pain. No statistical difference was detected between AO-B and AO-C.

Patients' expectations prior to surgery are high and partly unrealistic compared to the literature. Nevertheless most of the patients are satisfied with their overall results of the surgery afterwards although their peroperative expectations do not fully meet their postoperative fulfillment. In the context of patient satisfaction and the ratio "better in better out", it seems reasonable to better emphasize postoperative goals in order to improve patient satisfaction.