- •Open bicondylar tibial plateau fractures have a high rate of complications with a high incidence of Gustilo-Anderson type IIIB and C injuries.
- •Time to flap coverage greater than 7 days was associated with higher rates of deep infection and unplanned reoperation in this cohort.
- •Complication rates did not differ significantly after acute ORIF compared to staged management in the appropriately selected fracture.
Complete articular tibial plateau fractures are typically high-energy injuries associated with significant soft tissue trauma. The primary aim of this study was to evaluate the incidence of wound complications and need for soft tissue coverage after open, complete articular tibial plateau fractures. The secondary aim was to study the effect of timing of fixation and timing of flap coverage on deep infection rates in these injuries.
This was a retrospective cohort study of consecutive patients > 18 years undergoing ORIF of a Bicondylar Tibial Plateau (BTP) fracture between 2001 and 2018. Surgical data were recorded for open fractures including number of debridements, timing of definitive ORIF and soft tissue coverage relative to injury. Primary outcomes included rates of deep infection and unplanned reoperation.
508 AO/OTA 41C BTP fractures were identified, with 51 open fractures included in 50 patients with a mean (SD) age 45.7 (12.3) years and a mean (SD) follow up of 4.3 (3.8) years. There were 20 cases of deep infection, unplanned reoperation occurred in 26 cases. The majority of cases (28 fractures) had initial external fixation placed, while 24 had ORIF at the initial debridement. Twelve patients had a planned flap for definitive closure on average of 6.4 days (SD 3.9) after injury, 14 required a flap for wound complications. Among patients with IIB and C injuries, rates of deep infection (5/6 vs 1/6, p = 0.02) and reoperation (5/7 vs 2/6, p = 0.08) were higher in patients treated with flap coverage >7 days from injury compared to early flap coverage. There were no differences in complication rates between early (<24hrs) and delayed fixation.
Complete articular, open tibial plateau fractures are associated with high rates of complications. Time to flap coverage of seven days or more was a significant predictor of deep infection and unplanned reoperation in this cohort. Patients should be counseled about the high rate of unplanned reoperation and definitive soft tissue coverage should be accomplished within a week of injury whenever possible.
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- The tibial plateau fracture. The Toronto experience 1968-1975.Clin Orthop Relat Res. 1979; (NOC): 94-104
- Bicondylar tibial plateau fractures: a critical analysis review.JBJS Rev. 2018; 6: e4https://doi.org/10.2106/JBJS.RVW.17.00050
- Risk Factors of Infection After ORIF of Bicondylar Tibial Plateau Fractures.J Orthop Trauma. 2013; 27: e196-e200https://doi.org/10.1097/BOT.0b013e318284704e
- Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique.J Orthop Trauma. 2004; 18: 649-657https://doi.org/10.1097/00005131-200411000-00001
- Long-term outcomes after open reduction and internal fixation of bicondylar tibial plateau fractures.Injury. 2020; 51: 1097-1102https://doi.org/10.1016/j.injury.2020.03.003
- Risk factors for reoperation and mortality after the operative treatment of tibial plateau fractures in Ontario, 1996-2009.J Orthop Trauma. 2015; 29: 182-188https://doi.org/10.1097/BOT.0000000000000237
- Complications and unplanned outcomes following operative treatment of tibial plateau fractures.Injury. 2017; 48: 2221-2229https://doi.org/10.1016/j.injury.2017.07.016
- Functional evaluation in high energy (schatzker type v and type vi) tibial plateau fractures treated by open reduction and internal fixation.Int Sch Res Not. 2014; 2014: 1-8https://doi.org/10.1155/2014/589538
- Staged management of high-energy proximal tibia fractures (OTA types 41): the results of a prospective, standardized protocol.J Orthop Trauma. 2005; 19 (discussion 456): 448-455https://doi.org/10.1097/01.bot.0000171881.11205.80
- Costs and complications of single-stage fixation versus 2-stage treatment of select bicondylar tibial plateau fractures.J Orthop Trauma. 2018; 32: 327-332https://doi.org/10.1097/BOT.0000000000001167
- Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones.J Bone Jt Surg. 1975; 58: 523-527
- Classification of type III (severe) open fractures relative to treatment and results.Orthopedics. 1987; 10: 1781-1788
- Type III open tibia fractures: immediate antibiotic prophylaxis minimizes infection.J Orthop Trauma. 2015; 29: 1-6https://doi.org/10.1097/BOT.0000000000000262
- Early microsurgical reconstruction of complex trauma of the extremities.Plast Reconstr Surg. 1986; 78: 285-292https://doi.org/10.1097/00006534-198609000-00001
- Timing of microsurgical reconstruction in lower extremity trauma: an update of the godina paradigm.Plast Reconstr Surg. 2019; 144: 759-767https://doi.org/10.1097/PRS.0000000000005955
- Fix and flap: the radical orthopaedic and plastic treatment of severe open fractures of the tibia.J Bone Jt Surg - Ser B. 2000; 82: 959-966https://doi.org/10.1302/0301-620X.82B7.10482
- Single-stage orthoplastic reconstruction of Gustilo-Anderson Grade III open tibial fractures greatly reduces infection rates.Injury. 2015; 46: 2263-2266https://doi.org/10.1016/j.injury.2015.08.027
- Delay in flap coverage past 7 days increases complications for open tibia fractures: a cohort study of 140 North American trauma centers.J Orthop Trauma. 2019; 33: 161-168https://doi.org/10.1097/BOT.0000000000001434
- Timing of flap coverage with respect to definitive fixation in open tibia fractures.J Orthop Trauma. 2021; 35: 430-436https://doi.org/10.1097/BOT.0000000000002033
ACS TQIP BEST PRACTICES IN THE MANAGEMENT OF ORTHOPAEDIC TRAUMA. Published 2015. https://www.facs.org/media/mkbnhqtw/ortho_guidelines.pdf
- Is early definitive fixation of bicondylar tibial plateau fractures safe? An observational cohort study.J Orthop Trauma. 2017; 31: 151-157https://doi.org/10.1097/BOT.0000000000000779
- Primary versus delayed soft tissue coverage for severe open tibial fractures. A comparison of results.Clin Orthop Relat Res. 1983; : 54-63
- Two-stage combined ortho-plastic management of type IIIB open diaphyseal tibial fractures requiring flap coverage: is the timing of debridement and coverage associated with outcomes?.J Orthop Trauma. 2019; 33: 591-597https://doi.org/10.1097/BOT.0000000000001562
- Complications and soft-tissue coverage after complete articular, open tibial plafond fractures.J Orthop Trauma. 2021; 35: e371-e376https://doi.org/10.1097/BOT.0000000000002074
- Fracture and dislocation classification compendium-2018.J Orthop Trauma. 2018; 32: S1-S170https://doi.org/10.1097/BOT.0000000000001063
- Culture-negative infection after operative fixation of fractures.J Orthop Trauma. 2016; 30: 538-544https://doi.org/10.1097/BOT.0000000000000618
Surgical Site Infection Event. National healthcare safety network. Published 2022. Accessed February 11, 2022. https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf
- Complications of high-energy bicondylar tibial plateau fractures treated with dual plating through 2 incisions.J Orthop Trauma. 2015; 29: 85-90https://doi.org/10.1097/BOT.0000000000000203
- Outcomes of open bicondylar tibial plateau fractures treated with Ilizarov external fixator with or without minimal internal fixation.Eur J Orthop Surg Traumatol. 2013; 23: 349-355https://doi.org/10.1007/s00590-012-0989-9
Published online: December 12, 2022
Accepted: December 10, 2022
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