Nonunion and deep infections were common after staged open reduction and internal fixation of high-energy tibial plateau fractures, with higher rates of infection associated with open fractures and open fasciotomy wounds at the time of internal fixation, according to study results.
Researchers performed open reduction and internal fixation using medial and lateral plate construct through two incisions among 138 patients with 140 bicondylar plateau fractures. Primary outcomes assessed included the development of deep infection or nonunion necessitating return to the operating room, and secondary outcomes included unanticipated return to the operating room, superficial wound complications, deep venous thrombosis, pulmonary embolism, range of motion at last follow-up, neurologic or vascular injury, medical proximal tibial angle and implant failure or loosening.
Results showed an overall major complication rate of 27.9%, with 23.6% for deep infection and 10% for nonunion. The researchers found open fracture had a 43.8% rate of infection vs. 21% for closed injuries.
Compared with internal fixation with open fasciotomy wounds, fasciotomy closure before definitive fixation was associated with significantly fewer deep infection, according to study results. Results also showed no statistically significant association on the rate of infection or nonunion among patients with the presence of compartment syndrome, tobacco use, diabetes and timing of surgery. – by Casey Tingle
Disclosure: The researchers report no relevant financial disclosures.