What are the likely sequelae of a Schatzker 2 fracture of the tibia?

From the Guidelines

The likely sequelae of a Schatzker 2 fracture of the tibia include post-traumatic arthritis, knee stiffness, and potential malalignment, with a significant risk of long-term complications such as osteonecrosis, particularly in the metadiaphyseal region of the tibia. The Schatzker 2 fracture is a type of tibial plateau fracture that involves both depression and splitting of the lateral tibial plateau, creating a complex injury that can lead to various sequelae. In the short term, patients typically experience significant pain, swelling, and inability to bear weight, requiring surgical intervention with open reduction and internal fixation (ORIF) using plates and screws, often with bone grafting to elevate the depressed articular surface 1. Some potential complications of this fracture include:

• Post-traumatic arthritis, which can develop in 25-45% of patients within 5-10 years due to the initial cartilage damage and altered joint mechanics
• Knee stiffness, affecting approximately 20% of patients
• Malunion or hardware-related discomfort, which may necessitate additional surgeries
• Osteonecrosis, particularly in the metadiaphyseal region of the tibia, which can lead to further complications such as subchondral fracture and secondary osteoarthritis 1. The severity of these sequelae correlates with the degree of initial articular depression, quality of reduction, patient age, and presence of associated soft tissue injuries such as meniscal tears or ligament damage. Early diagnosis and treatment are crucial to prevent long-term complications and improve patient outcomes. Post-operatively, patients generally need 10-12 weeks of limited weight-bearing with progressive physical therapy focusing on range of motion exercises and quadriceps strengthening. It is essential to monitor patients closely for potential complications and adjust treatment plans accordingly to optimize outcomes.

From the Research

Likely Sequelae of Schatzker 2 Fracture of the Tibia

The likely sequelae of a Schatzker 2 fracture of the tibia include:

• Postoperative arthritis, as mentioned in the study 2
• Risk of infection, particularly in severe injuries 2
• Post-traumatic arthritis requiring knee arthroplasty, especially in high-energy impact injuries 2
• Articular subsidence, although the use of structural bone allografts has been shown to result in a negligible rate of articular subsidence 3
• Fracture malreduction, with a reported rate of 11.7% in one study 3
• Limited range of knee motion, with a reported mean range of 1.7°-123.6° (extension-flexion) in one study 4
• Numbness in the posteromedial inferior region of the calf, as reported in two patients in one study 4
• Dehiscence of the anterolateral incision and partial necrosis at the margin of the posteromedial incision, as reported in a few patients in one study 4

Factors Influencing Sequelae

The likelihood and severity of these sequelae may be influenced by factors such as:

• The severity of the fracture, with more severe fractures being at higher risk of complications 2
• The presence of comminuted or bicondylar fractures, which can increase the risk of postoperative arthritis and other complications 2
• The use of open surgical procedures, which can result in vast soft-tissue trauma and prolonged recovery 5
• The effectiveness of the surgical technique and fixation method used, with dual-plate fixation via a combined approach being shown to be effective in one study 4