Can we predict functional outcomes following tibial plateau fractures? The Plateau Fracture Indicator Variables Predicting Outcomes of Treatment (PIVOT) score

Objective: This study seeks to establish a score that may be used to identify patients at risk of poor functional outcome after tibial plateau fracture, in order to direct additional resources to that population.

Methods: Demographics, injury information, surgical management, and functional outcomes on the SMFA were prospectively collected from 423 tibial plateau fracture patients. Stepwise forward logistic regression was performed to generate a model predictive of patients’ likelihood of progressing to poor long-term clinical outcome.

Results: Of the 423 patients, 275 had operative intervention and complete data with minimum 12 months followup. Significant predictors of poor outcome were residual depression, general anesthesia, worker’s compensation, tobacco smoking, CCI, racial minority status, and alcohol abstinence. Applied to the validation cohort, it predicted outcomes with 75.9% sensitivity and 69.6% specificity. When functional status at 3 months was taken into account, significant predictors were 3-month SMFA, worker’s compensation, general anesthesia, CCI, and male gender. Applied to the validation cohort, it predicted outcomes with a 90.0% sensitivity and 68.4% specificity. Both models were significant, explaining 24.9% and 24.6% of variance in outcome with an AUC of 0.752 and 0.769, respectively.

Conclusion: The PIVOT model is a good predictor of poor functional outcome following operative repair of tibial plateau fracture.

Design: Prospective, observational study

Setting: Level 1 Trauma Center

Level of Evidence: Level III.