Predictive factors for knee stiffness after periarticular fracture: a case-control study

Area of Science:

• Orthopedic Surgery
• Trauma Surgery

Background:

• Knee stiffness is a significant complication following periarticular fractures.
• Systematic evaluation of risk factors and treatment outcomes for post-fracture knee stiffness is lacking.

Purpose of the Study:

• To identify risk factors for knee stiffness requiring manipulation after periarticular fracture.
• To document the clinical outcomes of manipulation for refractory knee stiffness.

Main Methods:

• A case-control study compared patients with periarticular fractures requiring manipulation under anesthesia (MUA) to those who did not.
• Twenty-four MUA cases were matched with 43 controls based on AO/OTA fracture classification.
• Billing data from a level-I trauma center was used to identify patients over a six-year period.

Main Results:

• Risk factors for stiffness included extensor mechanism disruption, fasciotomy, wounds needing ongoing management, and >2 surgical procedures.
• Mean improvement in knee motion after MUA was 62 degrees.
• Final knee flexion was significantly lower in the MUA group (107°) compared to controls (124°).

Conclusions:

• This is the first study to systematically evaluate risk factors and outcomes for knee stiffness after periarticular fracture.
• Injury characteristics that impede postoperative knee motion increase the risk of refractory stiffness.
• Late surgical intervention for knee stiffness improves flexion, though motion may remain compromised.