Etablierung einer multizentrischen Datenbank – Epidemiologie und klinisches Outcome von Tibiakopffrakturen

Neidlein, Claas (2025): Etablierung einer multizentrischen Datenbank – Epidemiologie und klinisches Outcome von Tibiakopffrakturen: eine retrospektive Analyse und klinische Untersuchung der postoperativen Instabilität. Dissertation, LMU München: Medizinische Fakultät

Abstract

The primary objective of the first study was to provide updated epidemiological data on tibial plateau fractures (TPF) in Germany. For this purpose, all TPF treated at the LMU Clinic over the past ten years (from January 2011 to Decem- ber 2020) were retrospectively analyzed regarding various epidemiological data. This analysis resulted in a database comprising 607 cases of TPF, which served as the foundation for numerous studies. This established database now provides the basis for prospective data collection on TPF across multiple regional trauma centers. The focus of the first study was twofold: first, to describe and analyze changes in fracture incidence in Germany for the first time, and second, to examine trends regarding fracture morphology, patients age, injury mechanism, and imaging modalities used for diagnosis. The main finding of the study is a significant increase in the incidence of TPF by 68% over the last decade. By the end of the study period, the incidence of TPF in Germany was reported as 23,4 per 100,000 peoples per year in 2020. Notably, the incidence in females (12,1/100,000) was significantly higher than in males (8,5/100,000) over the decade. Furthermore, there was a notably higher fracture incidence among elderly females (76-85 years), which was discussed in the con- text of osteoporosis. Regarding imaging techniques, it was demonstrated that computed tomography (CT) has become the standard modality for fracture diagnosis, with 91% of patients receiving CT imaging. In contrast, only 22% of patients underwent magnetic resonance imaging (MRI), which is discussed in more detail in the second study. Analysis of injury mechanisms revealed the following: the primary cause of injury across the patient cohort was falls, accounting for 32,9%. A closer look at young patients, those younger than the average cohort age (52,9 years), showed that most were male, and that the trauma mechanism was classified as “high-energy” (e.g., traffic accidents). In contrast, the older patient cohort was predominantly female, with “low-energy” trauma (e.g., falls) being the primary cause. Comparative analysis over the decade indicated that high-energy trauma mechanisms decreased overall, while low-energy mechanisms became more preva- lent. The second study aimed to analyze risk factors of the development of post-traumatic osteoarthritis (PTOA). This objective arose from the findings of the first study, which identified a significant increase in fracture incidence and noted that MRI is not a standard diagnostic tool for TPF. Additionally, other studies have shown high rates of PTOA following TPF. This led to a focus on a key risk factor for PTOA: post-traumatic knee instability. To investigate this, the database created in the first study was searched based on specific inclusion criteria to clinically assess knee instability in 54 patients. The main result of the study was a significant difference in anterior-posterior tibial translation as well as in tibial translation during internal rotation in the fractured knee compared to the healthy knee. Additionally, the injured knee showed signif- icant restrictions in range of motion. In conclusion, the study indicates that surgically treated TPF exhibit significant knee instability. Since knee instability is a known risk factor for PTOA, these findings explain the high rates of PTOA observed following tibial plateau fractures.

• Dokumententyp: Dissertationen (Dissertation, LMU München)
• Keywords: Tibial plateau fracture, Osteoporosis, post-traumatic osteoarthritis, instability
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften ; 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• Fakultäten: Medizinische Fakultät
• Sprache der Hochschulschrift: Deutsch
• Datum der mündlichen Prüfung: 25. Juni 2025
• 1. Bericht­erstatter:in: Fürmetz, Julian