Prospective Five-Point Serial Assessment of Radiological and Functional Outcome Dissociation After Locking Plate Fixation of Proximal Tibial Fractures.

introductionOrthopedic surgeons have traditionally assessed the success of tibial plateau fixation by evaluating radiological restoration of articular congruity, as observed on the initial postoperative X-ray. However, patient-centered outcomes such as pain, ambulation, knee stability, and return to work progress more slowly and in an unpredictable manner. This study investigated whether optimal radiological results on postoperative day 1 correspond to comparable functional recovery at six months, utilizing five serial assessments of both radiological and patient-focused functional outcomes in a prospective cohort treated with fracture morphology-guided locking plate fixation.

methodsA prospective observational study enrolled 32 patients with closed proximal tibial fractures (Schatzker types I-VI) over eight months (January-August 2023). Outcome assessment using the modified Rasmussen criteria was performed preoperatively and at the immediate postoperative, suture removal, three-month, and six-month intervals. Statistical analysis used the Friedman test with Wilcoxon signed-rank pairwise comparisons (p < 0.05).

resultsThe mean patient age was 38.53 ± 11.20 years, with 53.1% (17/32) male participants. Schatzker type IV fractures were most common (31.3%, n = 10). Bicolumnar dual plating was utilized in six patients (18.8%). The mean modified Rasmussen clinical score rose to 23.88 ± 1.96 at six months, and the radiological score rose from 0.78 ± 0.91 preoperatively to 8.44 ± 0.91 (both p < 0.001). At six months, all 32 patients (100%) had reached a good or excellent radiological grade (excellent 40.6%, n = 13; good 59.4%, n = 19), whereas only 14 patients (43.8%) had reached a good or excellent clinical grade; 18 (56.3%) remained fair, and just one (3.1%) achieved an excellent clinical grade. Radiological and clinical scores at six months showed no correlation (Spearman ρ = 0.101, p = 0.581), and none of the 13 patients with an excellent radiograph achieved an excellent functional grade. No complications were recorded on protocol-defined surveillance.

conclusionMorphology-guided proximal tibial fixation reliably restores radiological parameters by six months. Functional recovery, however, lags markedly behind and is uncorrelated with radiological score, with most patients still in the fair clinical grade at six months. This radiological-functional dissociation is reported here as an early postoperative observation; because functional recovery after tibial plateau fracture commonly continues for 12-24 months, the gap documented at six months is expected to narrow with longer follow-up, and its resolution cannot be characterized by this dataset. These findings derive from a small single-center cohort and require confirmation in larger multicenter studies. Nonetheless, they indicate that surgeons should not equate a satisfactory postoperative radiograph with treatment success and should audit outcomes with patient-related functional measures over adequate follow-up.