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Letter to the Editor “Decoding the myth regarding approaches in bicondylar tibial plateau fractures” by Theodore T. Guild, Derek S. Stenquist, Caleb M. Yeung, Mitchel B. Harris, Arvind G. Von Keudel, R. Malcolm Smith. July, 2022, Injury DOI:https://doi.org/10.1016/j.injury.2022.07.037

Published:November 12, 2022DOI:https://doi.org/10.1016/j.injury.2022.11.040
      We read the article “Single versus dual incision approaches for dual plating of bicondylar tibial plateau fractures have comparable rates of deep infection and revision surgery” by Guild et al., with great interest [
      • Guild T.T.
      • Stenquist D.S.
      • Yeung C.M.
      • Harris M.B.
      • Von Keudell A.G.
      • Smith R.M.
      Single versus dual incision approaches for dual plating of bicondylar tibial plateau fractures have comparable rates of deep infection and revision surgery.
      ]. The article has meticulously explained how a single incision dual plating can be performed, in a bicondylar tibia plateau fracture, and has a lower infection rate than hitherto reported. However, as readers, we feel the undermentioned points need to be explained in detail for better understanding.
      • 1.
        The authors have mentioned that this was a retrospective study conducted at 2 level one trauma centres. Out of all the patients, who were included, only 5 patients were excluded for posterior plating in 18 years. As mentioned in the article, these were probably coronal shear type posterior tibial plateau fractures. In the past decade or so, with changing fracture pattern, the frequency of posterior tibial plateau fractures has amplified. Barei et al. reported that one third of bicondylar tibia fractures had a posteromedial shear fragment [
        • Barei D.P.
        • O’Mara T.J.
        • Taitsman L.A.
        • Dunbar R.P.
        • Nork S.E
        Frequency and fracture morphology of the posteromedial fragment in bicondylar tibial plateau fracture patterns.
        ]. Due to this shift in the morphology of the fracture, the posteromedial fragment will necessitate extensive soft tissue dissection for placement of the implant with a single incision surgery, thereby increasing the risk of infection [
        • Barei D.P.
        • Nork S.E.
        • Mills W.J.
        • Henley M.B.
        • Benirschke S.K.
        Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique.
        ]. It shall be interesting to know the choice of incision when the fracture has a posterior component.
      • 2.
        Author has stated a higher infection rate in dual approach dual plating group as compared to the published literature [
        • Barei D.P.
        • Nork S.E.
        • Mills W.J.
        • Henley M.B.
        • Benirschke S.K.
        Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique.
        ]. It would be enlightening to know if they have some special reason/ hypothesis for the same.
      • 3.
        One of the advantages cited in the article is the use of the same incision in subsequent knee replacement surgeries. Wasserstein et al. reported a 7.3% incidence of total knee arthroplasty within 10 years of a proximal tibia fracture [
        • Wasserstein D.
        • Henry P.
        • Paterson J.M.
        • Kreder H.J.
        • Jenkinson R.
        Risk of total knee arthroplasty after operatively treated tibial plateau fracture: a matched-population-based cohort study.
        ]. The significance of a previous scar of more than 10 years duration for a subsequent surgery needs to be correlated.
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      References

        • Guild T.T.
        • Stenquist D.S.
        • Yeung C.M.
        • Harris M.B.
        • Von Keudell A.G.
        • Smith R.M.
        Single versus dual incision approaches for dual plating of bicondylar tibial plateau fractures have comparable rates of deep infection and revision surgery.
        Injury. 2022; (JulS0020138322005150)
        • Barei D.P.
        • O’Mara T.J.
        • Taitsman L.A.
        • Dunbar R.P.
        • Nork S.E
        Frequency and fracture morphology of the posteromedial fragment in bicondylar tibial plateau fracture patterns.
        J Orthop Trauma. 2008; 22 (Mar): 176-182
        • Barei D.P.
        • Nork S.E.
        • Mills W.J.
        • Henley M.B.
        • Benirschke S.K.
        Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique.
        J Orthop Trauma. 2004; 18 (Dec): 649-657
        • Wasserstein D.
        • Henry P.
        • Paterson J.M.
        • Kreder H.J.
        • Jenkinson R.
        Risk of total knee arthroplasty after operatively treated tibial plateau fracture: a matched-population-based cohort study.
        J Bone Joint Surg Am. 2014; 96 (Jan 15): 144-150