Does Time to Theatre Affect the Ability to Achieve Fracture Reduction in Tibial Plateau Fractures?

Abstract

Surgical management of displaced tibial plateau fracture (TPF) is often delayed due to accompanying soft tissue injuries sustained at the time of injury. The primary aim of this study was to assess the effect of time to surgery on fracture reduction in cases of TPF. The secondary aim was to assess the effect of preoperative demographics and residual articular step on Lysholm Scores and Knee Injury and Osteoarthritis Outcome Scores (KOOS) following fixation. Patients between 2006 and 2017, managed by a single surgeon, were prospectively enrolled in the study. Reduction of articular step, defined as <2 mm, was assessed by a single blinded examiner. A total of 117 patients were enrolled, 52 with Schatzker II, 4 with Schatzker IV, and 61 with Schatzker VI fractures. Patients were followed up to a mean of 3.9 years. Analysis showed that the ability to achieve fracture reduction was negatively influenced by time to theatre, with the odds of achieving reduction decreasing 17% with each subsequent day post injury (p = 0.002). Furthermore, an increased time to theatre was associated with a reduced Lysholm score at one year (p = 0.01). The ability to achieve fracture reduction did not influence PROMs within the study period. We conclude that delay in surgical fixation negatively affects fracture reduction in TPF and may delay recovery. However, residual articular step does not necessarily influence PROMs over the mid-term.

An Acute Fixation Protocol for High-Energy Tibial Plateau Fractures Decreases Time to Fixation and Lowers Operative Costs Without Affecting Wound Complications and Reoperations

“…Although the rate of deep SSI in this series was relatively high, it is comparable with previously reported deep SSI rates after ORIF from the same institution [10.3% (41/396)], the 2 aforementioned studies investigating acute fixation, and previous rates associated with staged protocols (5.0%-14.2%). 13,17,26 The rate of reoperation after tibial plateau fixation has historically been high, even with delayed fixation. Egol et al 13 reported a reoperation rate of 16% among 52 patients with Schatzker VI fractures undergoing delayed fixation.…”

“…3,4,[15][16][17] Although recent case series have supported the safety of acute fixation, there remain limited comparative studies investigating the safety of acute versus delayed ORIF of these fractures. 3,[15][16][17][18][19][20] The purpose of this study was to evaluate if utilization of an acute ORIF protocol at a single level 1 trauma center affected the incidence of wound complications in a cohort of patients with high-energy Schatzker IV/V/VI tibial plateau fractures. In addition, we aimed to examine the financial implications of these 2 treatment strategies by comparing total operative costs and hospital length of stay.…”

“…[11][12][13][14] Recently, some authors have argued that with careful soft tissue handling, acute ORIF of high-energy tibial plateau fractures can be safely done in selected patients, increasing the odds of anatomic reduction, shortening hospital length of stays, and avoiding the costs and complications associated with external fixation. 3,4,[15][16][17] Although recent case series have supported the safety of acute fixation, there remain limited comparative studies investigating the safety of acute versus delayed ORIF of these fractures. 3,[15][16][17][18][19][20] The purpose of this study was to evaluate if utilization of an acute ORIF protocol at a single level 1 trauma center affected the incidence of wound complications in a cohort of patients with high-energy Schatzker IV/V/VI tibial plateau fractures.…”

No delay in care of ambulatory orthopaedic fractures observed during the early Coronavirus-2019 pandemic: a retrospective cohort study

“…The treatment of many orthopaedic fractures, both operatively and nonoperatively, requires timeliness to allow for appropriate reduction and maintenance of alignment to allow for healing. Delays in treatment can result in changes to management, malunion, and increased complications 5–9…”

“…Delays in treatment can result in changes to management, malunion, and increased complications. [5][6][7][8][9] The goals of this study were to characterize the volume of ambulatory orthopaedic fractures that presented to a clinic and the emergency room immediately after the initial implementation of social distancing practices. The authors hypothesized that there would be an overall increased delay in care for ambulatory orthopaedic fracture patients during the early COVID-19 pandemic.…”