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Complications Associated With Internal Fixation of High-Energy Bicondylar Tibial Plateau Fractures Utilizing a Two-Incision Technique
- Source :
- Journal of Orthopaedic Trauma. 18:649-657
- Publication Year :
- 2004
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2004.
-
Abstract
- Objectives Single incision open reduction and double plate fixation of complex tibial plateau fractures has been associated with high wound complication rates. Minimally invasive methods have been recommended to decrease the wound complication rates as compared with open techniques. Additionally, laterally applied fixed-angle devices appear to minimize late varus deformity without the need for additional medial stabilization. Accurate reduction of comminuted lateral and/or medial articular surfaces, however, often requires visualization through an open reduction. This study reports the complications, infection rate, and radiographic assessment of reduction associated with double plating complex AO/OTA 41-C3 tibial plateau fractures utilizing 2 incisions. Design Retrospective clinical review. Setting Urban level 1 university trauma center. Patients Over a 77-month period, 83 patients were treated for a complex bicondylar tibial plateau fracture at our institution utilizing a 2-incision technique. Intervention Dual plating using anterolateral and posteromedial incisions. Main outcome measure Type and incidence of septic and non-septic complications and radiographic assessment of articular reduction and axial alignment. Results Eleven fractures were open (13.3%) and classified according to Gustilo as type II (1 patient), type III-A (7 patients), type III-B (2 patients), and type III-C (1 patient). Compartment syndrome was diagnosed and treated with fasciotomies in 12 patients (14.5%). The average time interval from injury to definitive surgical treatment was 9 days. Seven patients developed deep wound infections (8.4%). Three of these had an associated septic arthritis (3.6%). Clinical resolution of infection occurred after an average of 3.3 additional procedures. The presence of a dysvascular limb requiring vascular reconstruction was statistically associated with a deep wound infection (P = 0.006). Secondary procedures for complications included 13 patients who required removal of implants secondary to local discomfort, 5 patients who required a knee manipulation, 2 patients that were managed with excision of heterotopic ossification to improve knee motion, 1 patient that required an equinus contracture release, and 1 patient treated for a metadiaphyseal nonunion. Sixteen patients (19.3%) incurred deep venous thromboses. No patient was diagnosed with pulmonary embolism. Sixty-two percent of patients demonstrated satisfactory articular reductions, 91% demonstrated satisfactory coronal alignment, 72% demonstrated satisfactory sagittal alignment, and 98% demonstrated satisfactory condylar width. Conclusions Comminuted bicondylar tibial plateau fractures can be successfully treated with open reduction and medial and lateral plate fixation using 2 incisions. Dysvascular limbs requiring vascular repair are at increased risk for deep sepsis. The use of 2 incisions, temporary spanning external fixation, and proper soft-tissue handling may contribute to a lower wound complication rate than previously reported.
- Subjects :
- Adult
Male
medicine.medical_specialty
medicine.medical_treatment
Nonunion
Condyle
Fracture Fixation, Internal
External fixation
Postoperative Complications
Trauma Centers
Fracture fixation
Tibial plateau fracture
Humans
Medicine
Internal fixation
Orthopedics and Sports Medicine
Aged
Retrospective Studies
Aged, 80 and over
Varus deformity
business.industry
General Medicine
Middle Aged
medicine.disease
Surgery
Tibial Fractures
Female
Heterotopic ossification
business
Subjects
Details
- ISSN :
- 08905339
- Volume :
- 18
- Database :
- OpenAIRE
- Journal :
- Journal of Orthopaedic Trauma
- Accession number :
- edsair.doi.dedup.....3c3a701f6677fb2d2f05e782b3468f60