Hernández-Caicedo A, Santamaria-García J, Villa-Bandera J, Salgado-Leal C, Blanco-Granados C, Rivero-Centeno M

Language: Spanish
References: 17
Page: 139-144
PDF size: 242.30 Kb.

ABSTRACT

Introduction: high-energy bicondylar tibial plateau fractures involve extensive soft tissue damage and present significant postoperative risks, such as infections, venous thrombosis, and compartment syndrome. There is controversy regarding whether to manage these fractures with definitive surgical intervention or by using an external fixator as part of a staged management approach. Material and methods: this was a retrospective cohort study. Twenty-two patients with complex tibial plateau fractures were analyzed during the study period. Patients were assigned to three groups based on surgical management: group A (external fixator followed by definitive osteosynthesis), group B (definitive external fixator), and group C (definitive osteosynthesis). Sociodemographic variables, fracture type, and postoperative complications were evaluated, with statistical analysis used to compare outcomes. Results: most fractures were closed and resulted from motor vehicle accidents. Surgery was performed at an average of 7.86 days, with definitive osteosynthesis being the most common treatment (54.5%). Complications such as thromboembolism and infections were reported, but there were no immediate postoperative complications. Fracture consolidation was achieved in 95% of patients, with an average range of motion of 102 degrees, with no significant differences between treatments. Discussion: Schatzker V and VI fractures present significant challenges. Although fixation methods have their advantages and disadvantages, functional outcomes are positive with good consolidation and recovery of mobility. Conclusion: the choice of fixation type and timing of intervention should be based on a comprehensive evaluation of the patient and the fracture, considering potential complications to ensure adequate rehabilitation.

REFERENCES

1. Unno F, Lefaivre KA, Osterhoff G, Guy P, Broekhuyse HM, Blachut PA, et al. Is early definitive fixation of bicondylar tibial plateau fractures safe? An observational cohort study. J Orthop Trauma. 2017; 31(3): 151-7.

2. Boluda-Mengod J, Guimera-García V, Olías-López B, Renovell-Ferrer P, Carrera I, Herrera-Pérez M, et al. A proposal of a new algorithm for decision-making approaches in open reduction and internal fixation of complex tibial plateau fractures - SOTA algorithm (Spanish Orthopaedic Trauma Association). Injury. 2021; 52 Suppl 4: S87-98.

3. Giordano V, do Amaral NP, Koch HA, E Albuquerque RP, de Souza FS, Dos Santos Neto JF. Outcome evaluation of staged treatment for bicondylar tibial plateau fractures. Injury. 2017; 48 Suppl 4: S34-40.

4. Reátiga Aguilar J, Rios X, González Edery E, De La Rosa A, Arzuza Ortega L. Epidemiological characterization of tibial plateau fractures. J Orthop Surg Res. 2022; 17(1): 106.

5. Bove F, Sala F, Capitani P, Thabet AM, Scita V, Spagnolo R. Treatment of fractures of the tibial plateau (Schatzker VI) with external fixators versus plate osteosynthesis. Injury. 2018; 49 Suppl 3: S12-8.

6. Naja AS, Bouji N, Eddine MN, Alfarii H, Reindl R, Tfayli Y, et al. A meta-analysis comparing external fixation against open reduction and internal fixation for the management of tibial plateau fractures. Strategies Trauma Limb Reconstr. 2022; 17(2): 105-16.

7. Metcalfe D, Hickson CJ, McKee L, Griffin XL. External versus internal fixation for bicondylar tibial plateau fractures: systematic review and meta-analysis. J Orthop Traumatol. 2015; 16(4): 275-85.

8. Dobelle E, Fabre-Aubrespy M, Mandon B, Flecher X, Ollivier M, Argenson JN, et al. Bicondylar tibial plateau fracture osteosynthesis with double-plate fixation: Similar complication rates and clinical results but improved radiographic outcomes with dual compared to single approach. Orthop Traumatol Surg Res. 2024; 110(2): 103655.

9. Guild TT, Stenquist DS, Yeung CM, Harris MB, Von Keudell AG, Smith RM. Single versus dual incision approaches for dual plating of bicondylar tibial plateau fractures have comparable rates of deep infection and revision surgery. Injury. 2022; 53(10): 3475-80.

10. Rodriguez-Buitrago A, Basem A, Okwumabua E, Enata N, Evans A, Pennings J, et al. Hyperglycemia as a risk factor for postoperative early wound infection after bicondylar tibial plateau fractures: Determining a predictive model based on four methods. Injury. 2019; 50(11): 2097-102.

11. Li K, Zhang S, Qiu X, Huang H, Sheng H, Zhang Y, et al. Optimal surgical timing and approach for tibial plateau fracture. Technol Health Care. 2022; 30(S1): 545-51.

12. Egol KA, Tejwani NC, Capla EL, Wolinsky PL, Koval KJ. Staged management of high-energy proximal tibia fractures (OTA types 41): the results of a prospective, standardized protocol. J Orthop Trauma. 2005; 19(7): 448-55; discussion 456.

13. Tripathy SK, Varghese P, Panigrahi S, Panda BB, Srinivasan A, Sen RK. External fixation versus open reduction and internal fixation in the treatment of complex tibial plateau fractures: a systematic review and meta-analysis. Acta Orthop Traumatol Turc. 2021; 55(5): 444-56.

14. Zhao XW, Ma JX, Ma XL, Jiang X, Wang Y, Li F, et al. A meta-analysis of external fixation versus open reduction and internal fixation for complex tibial plateau fractures. Int J Surg. 2017; 39: 65-73.

15. Mesa L, Lufrano RC, Sajid MI, Flanagan C, Grewal IS, Bates P, et al. Acute versus staged fixation of bicondylar tibial plateau fractures: a dual centre international study. Eur J Orthop Surg Traumatol. 2024; 34(3): 1683-90.

16. Kitchen DS, Richards J, Smitham PJ, Atkins GJ, Solomon LB. Does time to theatre affect the ability to achieve fracture reduction in tibial plateau fractures? J Clin Med. 2021; 11(1): 138.

17. Patterson MJ, Cole JD. Two-staged delayed open reduction and internal fixation of severe pilon fractures. J Orthop Trauma. 1999; 13(2): 85-91.

EVIDENCE LEVEL

III