Unno Florence, Lefaivre Kelly A, Osterhoff Georg, Guy Pierre, Broekhuyse Henry M, Blachut Piotr A, OʼBrien Peter
Department of Orthopaedics, Division of Orthopaedic Trauma, University of British Columbia, Vancouver, BC, Canada.
J Orthop Trauma. 2017 Mar;31(3):151-157. doi: 10.1097/BOT.0000000000000779.
The optimal treatment protocol for bicondylar plateau fractures remains controversial. Contrary to popular practice which favors a staged protocol in many high-energy fracture patterns, we have used early single-stage open reduction and internal fixation (ORIF) to treat these injuries whenever possible. The purpose of this study was to determine the complication rate and the functional and radiographic outcomes of this strategy.
Retrospective cohort study and prospective data collection.
Level I trauma center.
PATIENTS/PARTICIPANTS: One hundred one patients with 102 OTA/AO type 41-C bicondylar tibial plateau fractures were treated with early definitive ORIF, defined as nonstaged surgery performed within 72 hours from injury. A subset of patients was part of a longitudinal study and reported functional outcomes at 1 year.
Early definitive ORIF.
Primary outcome: reoperation rate, defined as any surgery within 12 months after the index operation; secondary outcomes: quality and stability of radiographic fracture reduction; and functional outcome [Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and short musculoskeletal functional assessment (SMFA)].
Nonstaged operative treatment of bicondylar plateau fractures was performed in 91.3% of the fractures during the study period. For those, early definitive ORIF (surgery within 72 hours from injury) was performed in 82.3% fractures. Mean time from injury to ORIF, for closed fractures, was 29.8 hours. Sixteen (15.7%) fractures, which were treated with early definitive ORIF, required an additional surgical procedure within 12 months. Complications included wound infection requiring surgical management, compartment syndrome requiring fasciotomies, nonunion, early fixation failure, and implant removal for discomfort. The reoperation rate was 12.7% if implant removal was excluded. At least 3 of the 4 radiographic criteria used to assess the adequacy of reduction were achieved in 95.1% of cases, and all 4 criteria were met in 59.8% of fractures. The Physical Component of the SF-36 at 12 months was 42.6, which is comparable to values reported in previous studies for operative treatment of bicondylar plateau fractures.
In a model where surgery is performed without delay by experienced orthopaedic trauma surgeons, a large proportion of bicondylar tibial plateau fractures can be safely treated with early definitive ORIF. Early surgery was associated with satisfactory postoperative radiographic reductions.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
双髁平台骨折的最佳治疗方案仍存在争议。与许多高能骨折类型倾向于分期治疗方案的普遍做法相反，我们尽可能采用早期单阶段切开复位内固定术（ORIF）来治疗这些损伤。本研究的目的是确定该策略的并发症发生率以及功能和影像学结果。
回顾性队列研究和前瞻性数据收集。
一级创伤中心。
患者/参与者：101例患者共102处OTA/AO 41-C型双髁胫骨平台骨折接受了早期确定性ORIF治疗，早期确定性ORIF定义为受伤后72小时内进行的非分期手术。一部分患者是纵向研究的一部分，并报告了1年时的功能结果。
早期确定性ORIF。
主要结局指标：再次手术率，定义为初次手术后12个月内的任何手术；次要结局指标：影像学骨折复位的质量和稳定性；以及功能结局[医学结局研究36项简短健康调查（SF-36）和简短肌肉骨骼功能评估（SMFA）]。
在研究期间，91.3%的骨折采用了非分期手术治疗双髁平台骨折。其中，82.3%的骨折进行了早期确定性ORIF（受伤后72小时内手术）。闭合性骨折从受伤到ORIF的平均时间为29.8小时。16例（15.7%）接受早期确定性ORIF治疗的骨折在12个月内需要再次进行手术。并发症包括需要手术处理的伤口感染、需要进行筋膜切开术的骨筋膜室综合征、骨不连、早期内固定失败以及因不适而取出内固定物。如果排除取出内固定物的情况，再次手术率为12.7%。在用于评估复位充分性的4项影像学标准中，至少3项标准在95.1%的病例中得到满足，59.8%的骨折满足所有4项标准。12个月时SF-36的身体成分评分为42.6，与先前关于双髁平台骨折手术治疗报道的值相当。
在由经验丰富的骨科创伤外科医生立即进行手术的模式下，大部分双髁胫骨平台骨折可以通过早期确定性ORIF安全治疗。早期手术与术后影像学复位满意相关。
治疗性IV级。有关证据水平的完整描述，请参阅作者须知。
