There's Moore II it: assessing outcomes following tibial plateau fracture dislocations

The Moore type II tibial plateau fracture dislocation (M2) represents a specific subset of tibial plateau injuries. This study aims to assess outcomes for M2 fractures and examine the impact of surgical approach on recovery.

Patients were identified in a prospectively collected tibial plateau fracture database. Inclusion criteria included age ≥ 18 years, operative treatment, and minimum 1-year follow-up. Fractures were classified according to the systems of Schatzker et al. and Moore. Patients classified as Moore type 2 (M2) were identified and compared to all others. Demographic, injury, and surgical data were collected. Outcomes included knee range of motion (ROM), pain (VAS), and functional status (SMFA). M2 patients were categorized by surgical approach: medial (M), lateral (L), or combined (C). Statistical analyses were performed using Pearson Chi-Squared, t-tests, and ANOVA.

A total of 595 patients met inclusion criteria; 58 (10%) sustained an M2 fracture (mean follow-up = 28.34 months). The M2 cohort had fewer females (p = 0.048) and a higher complication rate (22.4% vs. 14.0%, p = 0.085). At 6 months, the M2 group had worse SMFA scores (p = 0.004), but by 1 year, differences were not significant (p = 0.199). Complications included knee contracture, fracture-related infections, venous thromboembolism events, and peroneal nerve issues. The combined surgical approach (C) had more external fixation use (50%) and poorer outcomes for pain and function compared to isolated approaches (p = 0.004, p = 0.041). The lateral approach (L) showed better ROM but was associated with higher rates of postoperative peroneal nerve injuries.

Moore type II fractures are complex, with poorer outcomes and higher complication rates than other tibial plateau fractures. Isolated medial surgery yields better results compared to combined approaches.