Is Early Definitive Fixation of Bicondylar Tibial Plateau Fractures Safe? An Observational Cohort Study

Unno, Florence; Lefaivre, Kelly A.; Osterhoff, Georg; Guy, Pierre; Broekhuyse, Henry M.; Blachut, Piotr A.; O’Brien, Peter J.

doi:10.1097/bot.0000000000000779

Cited by 28 publications

(31 citation statements)

References 38 publications

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“…The results of open reduction and internal fixation in Type V and VI Schatzker tibial plateau fractures are summarised in Table 5 . 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 Though the data is not objectively comparable due to lack of homogeneity between various studies, it can be inferred from Table 4 , Table 5 that internal fixation is associated with more number and frequency of complications.…”

Section: Discussionmentioning

confidence: 99%

Outcome of complex tibial plateau fractures with Ilizarov external fixation with or without minimal internal fixation

Subramanyam

Tammanaiah

Mundargi

et al. 2019

Chinese Journal of Traumatology

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Purpose To evaluate the clinico-radiological outcome of complex tibial plateau fractures treated with Ilizarov external fixation with or without minimal internal fixation. Methods This retrospective review was conducted on all the cases of Schatzker types V and VI tibial plateau fractures treated by Ilizarov external fixation between July 2006 and December 2015 with the minimum follow-up duration of one year. There were 30 patients: 24 males and 6 females, mean age 43.33 years, and mean follow-up 3.6 years. Three of them were open fractures; 15 cases were Schatzkertype V fractures and the other 15 type VI. According to AO/OTA classification, there were 11 type C1, 12 C2 and 7 type C3 fractures. Outcome assessment was made with American Knee Society Score (AKSS) and Rasmussen's Radiological Score (RRS) at final follow-up. Results Out of the 30 cases, mini-open reduction was performed in 7, bone graft in 4, minimal internal fixation in 10 and knee temporary immobilisation in 11 patients. Mean duration of external fixation was 11.8 weeks. All fractures united. Pin tract infections in 7 and common peroneal neuropathy in 2 patients were self-limiting. Two patients had axial misalignment of less than 10°. At final follow-up, the mean knee range of motion was 114.7, mean AKSS 81.5 and mean RRS 16.7. On statistical analysis, Schatzker type of fractures, use of minimal internal fixation and knee-spanning did not influence the final outcome. Conclusion Ilizarov external fixator with or without minimal internal fixation provides acceptable outcome for complex tibial plateau fractures. Care must be taken to look for minor loss of alignment, especially in Type VI Schatzker fractures after removal of the fixator. However small sample size precludes firm conclusions.

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Section: Discussionmentioning

confidence: 99%

Outcome of complex tibial plateau fractures with Ilizarov external fixation with or without minimal internal fixation

Subramanyam

Tammanaiah

Mundargi

et al. 2019

Chinese Journal of Traumatology

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“…Common practice favors staged protocol with spanning fixators [13, 31]. A recent retrospective cohort study reporting the results of early definitive fixation (within 72 h of injury) of bicondylar tibial plateau fractures (AO/OTA 41-C) showed a favorable 2.9% incidence rate of ACS [32]. However, this study might have been biased by the fact that the choice of timing and protocol was left at the discretion of the attending surgeon, potentially leading to lower Injury Severity Score (ISS) in the early definitive fixation group (11 vs. 17, p = 0.024) and to a strong trend for patients with open fractures to sustain a staged protocol (28,6% open fractures in the staged protocol group vs. 5.0% in the early definitive fixation population, p = 0.012).…”

Section: Discussionmentioning

confidence: 99%

Clinical and radiographic predictors of acute compartment syndrome in the treatment of tibial plateau fractures: a retrospective cohort study

Gamulin

Lübbeke

Belinga

et al. 2017

BMC Musculoskelet Disord

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BackgroundThe aim of the study was to evaluate the relation between demographic, injury-related, clinical and radiological factors of patients with tibial plateau fractures and the development of acute compartment syndrome.MethodsAll consecutive adult patients with intra-articular tibial plateau fractures admitted in our urban academic medical centre between January 2005 and December 2009 were included in this retrospective cohort study. The main outcome measurement was the development of acute compartment syndrome.ResultsThe charts of 265 patients (mean age 48.6 years) sustaining 269 intra-articular tibial plateau fractures were retrospectively reviewed. Acute compartment syndrome occurred in 28 fractures (10.4%). Four patients presented bilateral tibial plateau fractures; of them, 2 had unilateral, but none had bilateral acute compartment syndrome. Non-contiguous tibia fracture or knee dislocation and higher AO/OTA classification (type 41-C) were statistically significantly associated with the development of acute compartment syndrome in multivariable regression analysis, while younger age (<45 years), male sex, higher Schatzker grade (IV-V-VI), higher tibial widening ratio (≥1.05) and higher femoral displacement ratio (≥0.08) were significantly associated in the analysis adjusted for age and sex.ConclusionsTwo parameters related to the occurrence of ACS in tibial plateau fractures were highlighted in this study: the presence of a non-contiguous tibia fracture or knee dislocation, and higher AO/OTA classification. They may be especially useful when clinical findings are difficult to assess (doubtful clinical signs, obtunded, sedated or intubated patients), and should rise the suspicion level of the treating surgeon. In these cases, regular clinical examinations and/or intra-compartmental pressure measurements should be performed before and after surgery, even if acute compartment syndrome seemed unlikely during initial assessment. However, larger studies are mandatory to confirm and refine both factors in predicting the occurrence of acute compartment syndrome.

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“…Recent studies have reported acceptable results in both tibial pilon and plateau fractures in appropriately selected patients using contemporary surgical techniques. 24,25 Unno et al recently reported on a cohort of 102 non-consecutive OTA/AO 41C fractures, most treated in one stage less than 72 hours from injury. 24 They treated 91% with one operation, and 82% of these were treated with ORIF mostly (71%) through a single lateral approach.…”

Section: A C C E P T E Dmentioning

confidence: 99%

“…24,25 Unno et al recently reported on a cohort of 102 non-consecutive OTA/AO 41C fractures, most treated in one stage less than 72 hours from injury. 24 They treated 91% with one operation, and 82% of these were treated with ORIF mostly (71%) through a single lateral approach. They had an aggressive interpretation of soft tissue readiness, only using two-stage treatment in the face of circumferential blisters, necrosis, and medical issues preventing early surgery.…”

Section: A C C E P T E Dmentioning

confidence: 99%

“…Recent reports have suggested early definitive fixation is safe for lower extremity fractures when careful patient selection and sound surgical techniques are utilized. 24,25 The purpose of this study is to compare the outcomes and costs between BTP fractures treated in one versus two stages. We hypothesized that (1) outcomes of surgically treated BTP fractures would be equivalent for one-versus two-stage treatment with appropriate patient selection for each pathway and (2) that one stage treatment would convey significantly lower costs.…”

Section: Introductionmentioning

confidence: 99%

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Costs and Complications of Single-Stage Fixation Versus 2-Stage Treatment of Select Bicondylar Tibial Plateau Fractures

Virkus

Caballero

Kempton

et al. 2018

Journal of Orthopaedic Trauma

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Is Early Definitive Fixation of Bicondylar Tibial Plateau Fractures Safe? An Observational Cohort Study

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 28 publications

References 38 publications

Outcome of complex tibial plateau fractures with Ilizarov external fixation with or without minimal internal fixation

Outcome of complex tibial plateau fractures with Ilizarov external fixation with or without minimal internal fixation

Clinical and radiographic predictors of acute compartment syndrome in the treatment of tibial plateau fractures: a retrospective cohort study

Costs and Complications of Single-Stage Fixation Versus 2-Stage Treatment of Select Bicondylar Tibial Plateau Fractures

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