Session XI - Tibia

Sat., 10/7/06 Tibia, Paper #60, 10:51 am

Outcomes of Early Open Reduction & Internal Fixation of High-Energy Bicondylar Tibial Plateau Fractures

Jay B. Adlington, MD (n); Parth Lodhia, BSc (n);
Henry M. Broekhuyse, MD, FRCSC (a-Synthes);
Peter J. O'Brien, MD, FRCSC (a-Synthes);
Piotr A. Blachut, MD, FRCSC (a-Synthes);
Pierre Guy, MD, FRCSC (a-Synthes);
Robert N. Meek, MD, FRCSC (a-Synthes);
University of British Columbia Department of Orthopaedics, Trauma Division, Vancouver, British Columbia, Canada

Purpose: High-energy bicondylar tibial plateau fractures represent severe injuries both to the bone and the surrounding soft-tissue envelope. Historical data have demonstrated poor outcomes related to soft-tissue compromise and subsequent infection associated with early open reduction and internal fixation (ORIF) of these injuries. Temporary stabilization and delayed definitive ORIF when the soft-tissue envelope has been compromised has been advocated as a management strategy to minimize perioperative complications in these injuries. Our experience is that reduction of these injuries is easier early in the postinjury period, and that safe ORIF of these injuries can be performed within hours after the injury. The purpose of this study was to evaluate the perioperative complications and long-term quality of life outcomes in a series of patients who had undergone early ORIF of high-energy bicondylar tibial plateau fractures.

Methods: A retrospective review was undertaken of high-energy bicondylar tibial plateau fractures open fractures between December 1987 and April 2004. Inclusion criteria were as follows: AO C3 fracture pattern; age <60, ORIF as initial, definitive management; and minimum 1-year follow-up. 66 such patients were identified. 23 injuries were caused by falls from a height,23 by bicycle or pedestrian struck by car, 10 by motor vehicle collisions, and 10 by other means. Six injuries (9%) were open: one Gustilo Type I, two Gustilo Type II, two Gustilo Type IIIA, and one Gustilo Type IIIB. Median injury to operating room time was 31.8 hrs. 36 patients (55%) underwent a midline approach, 12 patients underwent anterolateral and posteromedial approaches (18%), and 9 (14%) were treated with a single medial or lateral approach. 45 patients (68%) underwent dual plating, 12 (18%) had a single plate, and 7 (11%) underwent treatment with a single locked plate. All patients ultimately achieved bony union. There were no amputations.

Results: Deep infection occurred in 7 patients (11%). Nonseptic complications occurred in 9 patients (13.6%) and included 3 nonunions, 2 failures of fixation, 2 wounds that could not be closed at the time of the ORIF, 1 malunion, and 1 compartment syndrome. All septic and aseptic complications required at least 1 further operative procedure. 33 patients (50%) complete mail-out follow-up questionnaires at mean 9.9 years postinjury. SF-36 and WOMAC scores were comparable to values in the normal population. SMFA outcomes were slightly worse than those in the normal population.

Conclusion/Significance: Septic and aseptic complication rates for early ORIF are comparable to those in the recent literature for delayed ORIF. Long-term quality of life outcome scores are similar to or slightly worse than those in the normal population. ORIF in high-energy bicondylar tibial plateau fractures can be safely undertaken by experienced surgeons within several days postinjury.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.