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Determination of outcomes of complex upper end tibial fractures in squatting and cross leg sitting South Asian population.

  • Goyal, Rakesh1
  • Goel, Shakti A2
  • Bhatia, Nishant3
  • 1 Senior Resident, Sports Injury Center, Ring Road, Safdarjung Enclave, New Delhi 110029, India. , (India)
  • 2 Consultant orthopaedic surgeon, Promhex Multispecialty Hospital, Omega 1, Greater Noida, Uttar Pradesh, India. , (India)
  • 3 Senior Resident, Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, 13, Bahadur Shah Zafar Marg, New Delhi 110002, India. Electronic address: [email protected] , (India)
Published Article
Publication Date
Jun 01, 2021
DOI: 10.1016/j.injury.2020.11.065
PMID: 33257016


Treatment of complex upper end tibial fractures has always been a challenge to orthopaedic surgeons. Though the roentgenogram results are satisfactory, the clinical and functional outcomes especially in terms of squatting/cross-leg sitting after long term follow-up are little known. Hence, we have done this study with a primary aim to assess the clinico-radiological and functional outcomes after operative fixation (mostly by locking plates) in complex upper end tibial fractures and a secondary aim to analyze correlation between functional outcome scores/range of motion (ROM) and the ability to squat & sit cross-legged in post-operative period. This prospective study included a total of 33 patients who were mainly treated with locking plates. In the follow-up, patients were assessed clinico-radiologically and outcome measurements were determined using the Tegner-Lysholm (T-L) Knee Score. Patients were categorized according to their ability to squat/sit cross-legged and a subgroup analysis was performed by comparing mean ROM and T-L score in each group. Majority of patients were in young and adult age group with a male to female ratio of 4.5:1. The average age was 42.39 ±14.64 years. Road traffic accident was the most common mode of injury. Average time interval between injury and surgery was 5.8±4.4 days. All the fractures united by 5-9 months. Mean ROM and T-L score at last follow-up were 120.94°±13.63° and 88.12±7.24 respectively. Average shortening, varus and valgus deformity were 0.43±0.09 cm, 2.12°±0.62° and 1.06°±0.45° respectively. 14 patients (42.42%) were able to squat and 15 (45.45%) were able to sit cross-legged postoperatively. Upon subgroup analysis, difference of mean ROM in those who could squat/sit cross-legged was found statistically significant (p≤0.05), however the difference in mean functional scores was not significant (p≥0.05). Complex upper tibial fractures are a difficult entity to deal with. Anatomical locking plates take care of the alignment, articular congruity as well as ligamentous balancing thus giving good mid-term outcomes after ORIF/MIPO. However, applicability of the present functional outcome scores in assessing squatting/cross leg sitting remains doubtful. More weightage needs to be given to these activities to evaluate the outcome in South Asian population. Copyright © 2020. Published by Elsevier Ltd.

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