Presentations at European Federation of Orthopaedic & Trauma Societies in Lyon, June 2025
Presentation 1
A Tender Spot: Medial Tibial Clues In The Clinical Presentation Of Knee OA
Background: There is variation in positive clinical signs of patients with severe knee osteoarthritis (KOA). Patients may have no tenderness at or overlying affected arthritic joint lines and other signs such as deformity, stiffness and instability may occur only in end-stage disease.
Methods: This observational study looked at the incidence of medial proximal tibial tenderness (MPTT) in a consecutive cohort of over 55-year-old patients, referred from primary care to our institution where a Standardised Knee Assessment Proforma was used. Aims were to define incidence and any demographic and pathology differences between patients with and without MPTT.
Results: Of 200 patient proformas analysed, 172 patients had complete data available for analysis. Medial proximal tibial tenderness (MPTT) was present in 76% of cases (131 patients). The 2 groups demonstrated near identical age (median 70), sex distribution, 60% female and median Body Mass Index (BMI) of 31, with subtle differences of higher mean BMI and lower, worse, Oxford Knee Scores (OKS) in the MPTT group. There were no differences between the 2 groups in terms of arthritis severity. Slightly more patients with MPTT (40%) had varus than those with no MPTT (34%) and the proportion going straight onto a waiting list for surgery was higher in the MPTT group (47% compared with 39%)
Key findings / Conclusions: There is a high incidence of MPTT which can occur in patients with non-medial OA. The MPTT group displayed worse knee scores for equivalent osteoarthritis severity.
MPTT is a previously unrecognised physical sign which may have implications for pre-operative presentation and post-surgery outcomes. It highlights the importance of careful clinical assessment and documentation, as this area of tenderness may become symptomatic in the early post-operative period and may be mistaken for an implant related problem.
Implications: Greater clinical awareness, teaching and further research are required.
Presentation 2
Changes In Patient Demography, Fracture Complexity And Surgical Management Of Proximal Tibial Fractures Over 2 Decades From An Interrupted Time Series Analysis – The Need For Greater Systemwide Vigilance And Better Documentation
Introduction: Open reduction internal fixation has remained treatment of choice for the majority of displaced intra-articular fractures of the proximal tibia, allowing optimisation of fracture healing and functional restoration.
Aim: To analyse changes in demography, injury types, method of fixation and early outcomes over a 2-decade timespan. Key question was: what changes, if any, have occurred over this timespan.
Methods: A single Centre, retrospective analysis of patients having surgery for closed intra-articular fractures of the proximal tibia AO/OTA 41A-C over two 5-year time periods from 2004-2008 and 2014-2018 was undertaken. Patients’ age, sex, injury mechanism, the presence of other significant injuries, comorbidities, fixation method undertaken, time to definitive surgery and early outcomes relating to length of stay and early post-operative complications 42 days from index surgery were noted.
Results: Over the 2-decade timespan there have been changes in the demography, fracture types and modes of fixation used. Demographics show a change towards older patients with a higher likelihood of comorbidities and with lower energy mechanisms injuries but are experiencing more complex fracture patterns, highlighted by the increase proportion of AO/OTA C2 and C3 fracture types in the later group. This has resulted in an observed increase in double and triple plate constructs. Despite this, there are reductions in time to surgery and total early complication rates.
Conclusions: This study confirms trends towards greater fracture complexity despite increasing patient age, comorbidities and lower energy injury mechanisms. These fractures now present a greater burden in terms of pre-operative planning, surgical time and surgical skillset requirements than previously. The overall complication rate of these fractures hasn’t altered and this may be related to patient and injury factors. These issues are unlikely to be known to health care commissioners or the wider Institution. Better on-going observation and documentation of such fractures is recommended.
