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Causes and treatment outcomes of revision surgery after open reduction and internal fixation of tibial plateau fractures

  • Seung Min Ryu
  • Chang Hyun Choi
  • Han Seok Yang
  • Wook Tae Park
  • Oog Jin Shon
  • Sam-Guk Park
Original Paper

Abstract

Purpose

Treatment of a tibial plateau fracture (TPF) remains controversial and is generally challenging. Many authors report good results after conventional open reduction and internal fixation in TPF, but complications still occur. This study analyzed causes and outcomes of revision surgery for TPF. The usefulness of a flow chart for revision surgery in TPF was also evaluated.

Methods

We reviewed all patients who underwent more than two operations for a TPF between 2008 and 2015. Finally, 24 cases were selected and retrospectively investigated. The medial tibial plateau angle and proximal posterior tibial angle were radiologically evaluated. The American Knee Society Score (AKSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), range of motion (ROM), and bone union time were investigated after surgery.

Results

Revision surgery for infection was performed in eight cases, for nonunion in six cases, for posttraumatic arthritis (with total knee arthroplasty) in six cases, and for other reasons in four cases. The mean clinical AKSS at final follow-up was 87.3 ± 5.3 (range, 75–95), the functional AKSS was 81.9 ± 5.5 (range, 70–90), the WOMAC score was 9.9 ± 3.1 (range, 5–16), the flexion ROM was 119.8 ± 16.5° (range, 100–150°), and the extension ROM was 2.5 ± 3.3° (range, 0–10°).

Conclusions

Although complications cannot be avoided in some cases, good clinical outcomes are possible when patients are divided according to the presence or absence of infection, with selection of appropriate revision surgery as shown in the flow chart. If an infection is present, treatment should be based on the presence or absence of bone union. If there is no infection, treatment should be based on the presence or absence of nonunion, post-traumatic arthritis, malunion, or immediate post-operative malreduction.

Keywords

Tibial fracture Postoperative complications Reoperation Flow chart 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Apley AG (1979) Fractures of the tibial plateau. Orthop Clin North Am 10:61–74PubMedGoogle Scholar
  2. 2.
    Ibsen JG, Mossing N (1971) Conservative treatment of tibial condylar fractures. Acta Orthop Scand 42:431–432PubMedGoogle Scholar
  3. 3.
    Sarmiento A, Kinman PB, Latta LL, Eng P (1979) Fractures of the proximal tibia and tibial condyles: a clinical and laboratory comparative study. Clin Orthop Relat Res:136–145Google Scholar
  4. 4.
    Papagelopoulos PJ, Partsinevelos AA, Themistocleous GS, Mavrogenis AF, Korres DS, Soucacos PN (2006) Complications after tibia plateau fracture surgery. Injury 37:475–484.  https://doi.org/10.1016/j.injury.2005.06.035 CrossRefPubMedGoogle Scholar
  5. 5.
    Barei DP, Nork SE, Mills WJ, Henley MB, Benirschke SK (2004) Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique. J Orthop Trauma 18:649–657CrossRefPubMedGoogle Scholar
  6. 6.
    Young MJ, Barrack RL (1994) Complications of internal fixation of tibial plateau fractures. Orthop Rev 23:149–154PubMedGoogle Scholar
  7. 7.
    Ryu SM, Yang HS, Shon OJ (2018) Staged treatment of bicondylar tibial plateau fracture (Schatzker type V or VI) using temporary external fixator: correlation between clinical and radiological outcomes. Knee Surg Relat Res.  https://doi.org/10.5792/ksrr.17.008
  8. 8.
    Lin S, Mauffrey C, Hammerberg EM, Stahel PF, Hak DJ (2014) Surgical site infection after open reduction and internal fixation of tibial plateau fractures. Eur J Orthop Surg Traumatol 24:797–803.  https://doi.org/10.1007/s00590-013-1252-8 CrossRefPubMedGoogle Scholar
  9. 9.
    Moore TM, Patzakis MJ, Harvey JP (1987) Tibial plateau fractures: definition, demographics, treatment rationale, and long-term results of closed traction management or operative reduction. J Orthop Trauma 1:97–119CrossRefPubMedGoogle Scholar
  10. 10.
    Li J, Zhu Y, Liu B, Dong T, Chen W, Zhang Y (2018) Incidence and risk factors for surgical site infection following open reduction and internal fixation of adult tibial plateau fractures. Int Orthop 42:1397–1403.  https://doi.org/10.1007/s00264-017-3729-2 CrossRefPubMedGoogle Scholar
  11. 11.
    Lansinger O, Bergman B, Korner L, Andersson GB (1986) Tibial condylar fractures. A twenty-year follow-up. J Bone Joint Surg Am 68:13–19CrossRefPubMedGoogle Scholar
  12. 12.
    Yang EC, Weiner L, Strauss E, Sedlin E, Kelley M, Raphael J (1995) Metaphyseal dissociation fractures of the proximal tibia. An analysis of treatment and complications. Am J Orthop (Belle Mead NJ) 24:695–704Google Scholar
  13. 13.
    Weiner LS, Kelley M, Yang E, Steuer J, Watnick N, Evans M, Bergman M (1995) The use of combination internal fixation and hybrid external fixation in severe proximal tibia fractures. J Orthop Trauma 9:244–250CrossRefPubMedGoogle Scholar
  14. 14.
    Honkonen SE (1995) Degenerative arthritis after tibial plateau fractures. J Orthop Trauma 9:273–277CrossRefPubMedGoogle Scholar
  15. 15.
    Chao EY, Neluheni EV, Hsu RW, Paley D (1994) Biomechanics of malalignment. Orthop Clin North Am 25:379–386PubMedGoogle Scholar
  16. 16.
    Paley D, Herzenberg JE, Tetsworth K, McKie J, Bhave A (1994) Deformity planning for frontal and sagittal plane corrective osteotomies. Orthop Clin North Am 25:425–465PubMedGoogle Scholar
  17. 17.
    Schatzker J, McBroom R, Bruce D (1979) The tibial plateau fracture. The Toronto experience 1968--1975. Clin Orthop Relat Res:94–104Google Scholar
  18. 18.
    Gaunder CL, Zhao Z, Henderson C, McKinney BR, Stahel PF, Zelle BA (2018) Wound complications after open reduction and internal fixation of tibial plateau fractures in the elderly: a multicentre study. Int Orthop.  https://doi.org/10.1007/s00264-018-3940-9
  19. 19.
    Krettek C, Hawi N, Jagodzinski M (2013) Intracondylar segment osteotomy: correction of intra-articular malalignment after fracture of the tibial plateau. Unfallchirurg 116:413–426.  https://doi.org/10.1007/s00113-013-2377-2 CrossRefPubMedGoogle Scholar
  20. 20.
    Van Nielen DL, Smith CS, Helfet DL, Kloen P (2017) Early revision surgery for tibial plateau non-union and mal-union. HSS J 13:81–89.  https://doi.org/10.1007/s11420-016-9529-1 CrossRefPubMedGoogle Scholar
  21. 21.
    Blokker CP, Rorabeck CH, Bourne RB (1984) Tibial plateau fractures. An analysis of the results of treatment in 60 patients. Clin Orthop Relat Res:193–199Google Scholar
  22. 22.
    DeCoster TA, Nepola JV, el-Khoury GY (1988) Cast brace treatment of proximal tibia fractures. A ten-year follow-up study. Clin Orthop Relat Res:196–204Google Scholar
  23. 23.
    Hohl M (1967) Tibial condylar fractures. J Bone Joint Surg Am 49:1455–1467CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Seung Min Ryu
    • 1
  • Chang Hyun Choi
    • 1
  • Han Seok Yang
    • 1
  • Wook Tae Park
    • 1
  • Oog Jin Shon
    • 1
  • Sam-Guk Park
    • 1
  1. 1.Department of Orthopedic SurgeryYeungnam University Medical CenterDaeguSouth Korea

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