Highlights
- •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.
Abstract
Purpose
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.
Methods
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.
Results
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.
Conclusions
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.
Keywords
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Article info
Publication history
Published online: December 12, 2022
Accepted:
December 10,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
