Complications in the management of closed high-energy proximal tibial plateau fractures

Abstract

PurposeTo report complications in the management of complex closed proximal tibial fractures.MethodA retrospective study was conducted to analyze the infectious and noninfectious complications encountered in the management of high-energy Schatzker type V and VI tibial plateau fractures. All patients were treated at the level 1 trauma centre between January 2011 and March 2014. Sixty two patients were included in the study. The mean patient age was (43.16 ± 11.59) years with 60 males and 2 females. Infectious complications like superficial and deep infection, wound dehiscence, malalignment in the immediate postoperative period and in follow-up period were noted.ResultsThe overall complication rate was 30.65% (19 out of 62). Infectious complications were noted in 20.97% cases (13/62). In majority of the cases (8/13), superficial infection was seen which managed with regular dressing and antibiotic administration. The patients (5/13) who had developed deep-seated infection were subjected to repeated debridements, flap coverage, implant removal or amputation depending upon the host response. Thirteen patients had experienced noninfectious complications. Hardware related complications were noticed in six patients and four among them received a secondary procedure. Malalignment was observed in seven patients but only single patient underwent subsequent operative intervention.ConclusionProximal tibial plateau fractures especially Shatzker type V and VI are associated with extensive soft tissue damage even in closed injuries. The complications encountered in the management of these fractures can be minimized with appropriate patient selection and minimal soft tissue dissection.

Primary Total knee Arthroplasty: A Viable Surgical Option for Complex Tibial Plateau Fractures in Elderly

“…Metal wedges in four patients were added, if the defect was 3 mm or deeper from the inferior surface of the tibial component and involved one-third or more of the medial or lateral compartment (►Figs. 2,3). The deficient part was fashioned to approximate the metal block size and thickness.…”

“…The joint reduction was acceptable if the articular depression or tibial condylar widening was 5 mm. 3 The postoperative alignment should be within 0 to 3 degrees of the mechanical axis. 19 It was categorized into three groups: valgus (!…”

“…2 They are challenging and problematic to treat, especially in the elderly age group, because of the increased complication rate associated with the use of locking plates, for example, infection, malalignment, peroneal nerve palsy, and hardware-related problems, as well as the rapid progression of secondary osteoarthritis (OA). [3][4][5] Pre-existing arthritis, disruption of the articular cartilage, suboptimal reduction, and failure of fixation due to poor bone stock are the expected challenges. 6 A three-fold increase in degenerative changes was reported after geriatric plateau fractures due to the mounting effect of cartilaginous damage on the degenerate knee.…”

Combined lateral peripatellar and posteromedial approaches for Schatzker type IV tibial plateau fractures involving posteromedial plane: a prospective study

“…Schatzker type IV fractures are described as the fractures involving the medial plateau [1]. They account for 10-30% of all tibial plateau fractures [2,3]. The type IV fractures commonly result from high-energy trauma, and usually accompany with associated injuries of meniscus and ligaments [3,4], Therefore, the treatment is still difficult in clinical practice, especially the fractures involving posteromedial plane.…”

Incidence and risks for surgical site infection after closed tibial plateau fractures in adults treated by open reduction and internal fixation: a prospective study

“…However, there were many potential complications of surgical treatment after tibial plateau fracture, including SSI, joint stiffness, traumatic osteoarthritis, delayed or non-union. [2][3][4], Among the complications, SSI was the most common one. Previous literature had reported that SSIs developed at 2-14.2% of patients after they underwent ORIF, half of which were deep infections [5][6][7].…”