•Time to Spanning External Fixation for High-Energy Tibial Plateau and Plafond Fractures has No Impact on Rates of Infection, Compartment Syndrome, or Secondary Procedures

Session V - Knee / Tibia

Fri., 10/11/13 Knee/Tibia, PAPER #61, 2:53 pm OTA 2013

•Time to Spanning External Fixation for High-Energy Tibial Plateau and Plafond Fractures has No Impact on Rates of Infection, Compartment Syndrome, or Secondary Procedures

Justin Haller, MD; David Holt, MD; Erik Kubiak, MD; Thomas F. Higgins, MD;
University of Utah, Salt Lake City, Utah, USA

Purpose: The purpose of the study is to retrospectively investigate if the time delay to spanning external fixation of high-energy tibial plateau and plafond fractures had any impact on rate of complications, time to definitive fixation, secondary procedures, and length of stay (LOS). Our hypothesis is that these outcomes will be no different in patients who underwent early versus late fixation.

Methods: We retrospectively reviewed patients greater than 18 years of age who presented to our Level I trauma center with a high-energy tibial plateau (Schatzker IV-VI) or tibial plafond fracture requiring provisional external fixation followed by definitive repair from 2006-2012. Patients were excluded if they had less than 6 months of follow-up or did not receive both the temporizing and definitive surgeries at our institution. Patients who received surgery <12 hours after injury were classified as early external fixation (EEF) and those who underwent surgery >12 hrs after injury constituted the delayed external fixation group (DEF). Demographic data including age, sex, tobacco use, mechanism, and comorbidities were recorded. Infection, LOS, time to definitive fixation, and secondary surgeries (after definitive fixation) were recorded.

Results: Between 2006 and 2012, 215 (109 tibial plateaus and 96 tibial plafonds) fractures met inclusion criteria. 63 (39 plateaus and 24 plafonds) patients were excluded for <6 months follow-up. There were 76 patients (37 plateaus and 38 plafonds) in the EEF cohort with a mean age of 41.8 (range, 20-77) and 72% were male. There were 66 patients (33 plateaus and 34 plafonds) in the DEF cohort with a mean age of 43.2 (range, 19-66) and 70% were male. Average follow-up was similar between early (13.4 months; range, 6-68) and delayed (16.47 months; range, 6-70) groups (P = 0.17). Subgroup analysis of plafond fractures demonstrated there were 24 open injuries (33.3%) and an overall infection rate of 22.2%. Similarly, there were 7 open plateau fractures (10%) and an overall infection rate of 20%. There were significantly more open plafonds in the early group (P = 0.045), but there was no significant difference in the number of open plateau fractures in the early group (P = 0.11). Using linear regression controlling for open fracture, there was no significant difference in infection between early versus late fixation for plafond fractures (P = 0.42) or plateau fractures (P = 0.32). Overall rate of compartment syndrome was 8.6% in plateau fractures and 7.9% in plafond fractures; these rates were no different between EEF and DEF for plateaus (P = 0.29) or plafonds (P = 1.0). There was no difference between EER and DEF for LOS for plafond fractures (P = 0.88) or plateau fractures (P = 0.12). Plateau fractures in the EEF group underwent definitive fixation a mean of 8.46 days after initial fixation compared to 11.5 days for those in the DEF group (P = 0.058). There was no difference in time to definitive fixation for plafond fractures (P = 0.80). Overall, 61% of plateau and 46% of plafond patients required secondary surgery. There was no difference in number of patients requiring secondary surgeries or overall number of secondary surgeries between early and delayed fixation for either plateau (P = 0.46, P = 0.19) or plafond fractures (P = 0.10, P = 0.11).

Conclusion: There is no detectable difference in rates of infection, secondary surgeries, or hospital stay between patients with high-energy tibial plateau or plafond fractures receiving provisional external fixation <12 hours versus >12 hours. There was a trend toward fewer days to definitive fixation in patients with a plateau fracture who were spanned early; this difference was not present for plafond fractures.

Alphabetical Disclosure Listing

• 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.