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Acute versus staged fixation of bicondylar tibial plateau fractures: a dual centre international study

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

Bicondylar tibial plateau fractures pose many treatment challenges due to their complex fracture patterns and associated soft tissue compromise. We aim to evaluate outcomes of acute ORIF (aORIF) versus staged ORIF (sORIF) of high energy bicondylar tibial plateau fractures.

Methods

We retrospectively reviewed 186 patients at two high-volume Level I trauma centers. One hundred one patients underwent aORIF and 85 underwent sORIF between 2011 and 2019. Clinical outcomes of interest included operative time, wound dehiscence, superficial and deep infection, nonunion, flap coverage, arthrodesis, and early conversion to arthroplasty.

Results

Patients had a median follow up of 12 months (6–98 months). The sORIF group had a higher ISS (p = 0.02) and a higher rate of open fractures (24.7% vs 11.9%, p = 0.03). The groups were statistically similar in other demographics and co-morbidities. Operative time was significantly shorter in the aORIF group (157 vs 213 min., p < 0.001). There was no statistical difference in wound dehiscence, deep infection, flap coverage, nonunion, unplanned reoperation, or post-traumatic arthritis between groups. However, aORIF was associated with a significantly lower rate of superficial infection (p = 0.01), arthroplasty (p = 0.003) and unplanned reoperation (p = 0.005). Subgroup analysis of only the 41C3 fractures showed a lower rate of superficial infections in the aORIF group (p = 0.04). No difference in complications was found between the fracture subgroups.

Conclusion

We found no increased risk of complications with aORIF compared to sORIF for bicondylar tibial plateau fractures. While not all injuries may be appropriate for aORIF, our results demonstrate the safety of aORIF when patients are properly selected by experienced fracture surgeons.

Level of evidence

Level III.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of South Florida, Tampa, USA

    Lazaro Mesa, Christopher Flanagan, Hassan R. Mir, Paul Jordan Hannon, Spencer Albertson, Joshua Mizels, John Wilson, Reed Andrews & Joseph Michalski

  2. Orthopaedic Trauma Service, Florida Orthopaedic Institute, 5- Tampa General Circle, Tampa, FL, 33606, USA

    Reuben C. Lufrano, Mir Ibrahim Sajid, Christopher Flanagan, Ishvinder S. Grewal, Hassan R. Mir, David T. Watson, Anjan R. Shah, Benjamin Maxson, David Donohue, Anthony F. Infante, Katheryne Downes & Roy Sanders

  3. Royal London Hospital, London, UK

    Peter Bates

  4. Department of Orthopaedic Surgery, Royal London Hospital, London, UK

    Nicholas Birkett, Rutba Chatta, Melihah Hassan, David Ensor, Pramod Achan & Peter Bates

Authors
  1. Lazaro Mesa
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  2. Reuben C. Lufrano
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  3. Mir Ibrahim Sajid
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  4. Christopher Flanagan
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  5. Ishvinder S. Grewal
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  6. Peter Bates
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  7. Hassan R. Mir
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Consortia

Tibial Plateau Study Group

  • Paul Jordan Hannon
  • , Spencer Albertson
  • , Nicholas Birkett
  • , Rutba Chatta
  • , Melihah Hassan
  • , Joshua Mizels
  • , David Ensor
  • , John Wilson
  • , Reed Andrews
  • , Joseph Michalski
  • , Pramod Achan
  • , David T. Watson
  • , Anjan R. Shah
  • , Benjamin Maxson
  • , David Donohue
  • , Anthony F. Infante
  • , Peter Bates
  • , Katheryne Downes
  •  & Roy Sanders

Corresponding author

Correspondence to Hassan R. Mir.

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All authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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An IRB review was carried out for this study and was found eligible for exemption. This material is the authors' own original work, which has not been previously published and is not currently being considered for publication elsewhere.

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Mesa, L., Lufrano, R.C., Sajid, M.I. et al. Acute versus staged fixation of bicondylar tibial plateau fractures: a dual centre international study. Eur J Orthop Surg Traumatol 34, 1683–1690 (2024). https://doi.org/10.1007/s00590-023-03815-4

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  • DOI: https://doi.org/10.1007/s00590-023-03815-4

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