DOI: 10.3928/01477447-20260904-01 ISSN: 0147-7447

Complications in Acute Versus Delayed Definitive Fixation of Bicondylar Tibial Plateau Fractures

Ellen Lutnick, Diane Ghanem, Hamza M. Raja, Alexandra Spath, Jamie J. Bousleiman, Brad Siler, Christian Freitag, Andrew Hannoudi, Colton L. Clymer, Nicholas Daher, Jacob Geiger, Muhammad J. Abbas, Dustin Morgan, Christopher Ritter, Christopher Mutty, Lisa Cannada, Stuart Guthrie, Babar Shafiq
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Background:

This study compared outcomes of bicondylar tibial plateau fractures treated with staged versus acute definitive fixation.

Materials and Methods:

A multicenter retrospective review at 3 academic level 1 trauma centers included adult patients treated surgically for bicondylar tibial plateau fractures, grouped by treatment strategy: staged fixation (external fixation followed by open reduction internal fixation [ORIF]) or acute ORIF within ≤72 hours, comparing quality of reduction and complications, including unplanned return to the operating room.

Results:

A total of 96 patients were treated with staged ORIF (group 1) and 74 with acute ORIF ≤72 hours (group 2). Length of stay was longer ( P = .011) and incidence of complication higher in group 1 (31% vs 14%; P = .013). Wound dehiscence and drainage were significantly higher in group 1; concomitant compartment syndrome and wound vacuum-assisted closure were also highest in this group. There were no differences in AO/OTA classification across groups ( P = .13); however, more complex fractures were associated with infection ( P = .026) and longer delays to definitive surgery ( P = .046). Quality of reduction was similar between groups. Patients in group 2 were less frequently treated definitively with >1 plate (16% vs 84%; P < .001). Those treated with >1 plate had higher incidence of any complication (14% vs 44%; P < .001). On backwards logistic regression, patients treated with early definitive fixation were 65% less likely to have any complication ( P = .022). Any complication, osteoporosis, and cerebrovascular disease significantly increased risk of unplanned return to the operating room.

Conclusion:

Early definitive ORIF is safe for select bicondylar tibial plateau fractures.

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