Sat., 10/6/12 Femur/Tibial Fx/Knee Injuries, PAPER #79, 9:21 am OTA-2012
Complications of High-Energy Bicondylar Tibial Plateau Fractures Treated With Dual Plating Through Two Incisions
Michael R. Ruffolo, MD; Harvey E. Montijo; Franklin K. Gettys; Rachel B. Seymour;
Madhav A. Karunakar, MD;
Carolinas Medical Center, Charlotte, North Carolina, USA
Purpose: The purpose of this study is to characterize the rate of complications following operative fixation of Schatzker 6 (OTA 41-C3) tibial plateau fractures and to evaluate the contribution of common risk factors.
Methods: An IRB-approved retrospective review was performed on 246 consecutive patients treated for bicondylar tibial plateau fractures at a single institution over a 6-year period. 138 patients with 140 fractures met our inclusion criteria of OTA 41-C3 classification, treated by open reduction and internal fixation using a dual plate construct and two incisions, and follow-up until union or 1 year. Injuries were classified as open or closed and by the presence of compartment syndrome. Demographic data including age, gender, body mass index (BMI), mechanism of injury, tobacco use, and time to definitive fixation were recorded. BMI was analyzed as a dichotomous variable using the National Institutes of Health definition for obesity class II (BMI >35). The primary outcomes evaluated were nonunion and deep infection. Deep infection was defined as irrigation and débridement requiring return to the operating room and a positive deep wound culture. Nonunion was defined as revision fixation for insufficient healing at a minimum of 6 months after the index procedure.
Results: 16 patients (11.6%) had open fractures, and 25 (18.1%) had compartment syndrome. The average follow-up was 64.5 weeks (range, 12-303 weeks). The average time from injury to definitive fixation was 12.5 days (range, 1-35 days). The overall major complication rate was 27.9%: 23.6% deep infection and 10.0% nonunion. Open fractures were associated with a higher rate of infection, 43.8% compared to 21.0% for closed injuries (P = 0.02), and a higher, but nonsignificant ,increased risk of nonunion, 18.8% compared to 8.9% closed (P = 0.11). Patients with a BMI >35 had a significantly higher nonunion rate: 21.1% compared to 6% in those with a BMI <35 (P = 0.03); however, infection rates were similar. There was no significant difference in the rate of infection or nonunion for diabetic patients; however, a nonsignificant increased rate of nonunion was observed: 22.2% compared to 7.8% in nondiabetics (P = 0.08). Fasciotomy closure/coverage prior to definitive fixation resulted in significantly fewer deep infections compared with internal fixation with open fasciotomy wounds: 11.8% compared to 50% (P = 0.02). The presence of compartment syndrome, tobacco use, and timing of surgery had no impact on the rate of infection or nonunion.
Conclusions: (1) Nonunion and deep infections occur commonly after staged open reduction and internal fixation of high-energy tibial plateau fractures. (2) A BMI >35 was significantly associated with a higher rate of nonunion (P = 0.03). (3) Open fractures and open fasciotomy wounds at time of definitive fixation were significantly associated with higher rates of infection (P = 0.02).
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• 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. Δ OTA Grant.