Khatri Kavin, Sharma Vijay, Goyal Darsh, Farooque Kamran
Department of Orthopaedics, GGS Medical College and Hospital, Punjab, India.
Chin J Traumatol. 2016 Dec 1;19(6):342-347. doi: 10.1016/j.cjtee.2016.08.002.
To report complications in the management of complex closed proximal tibial fractures.
A retrospective study was conducted to analyze the infectious and noninfectious complications encountered in the management of high-energy Schatzker type V and VI tibial plateau fractures. All patients were treated at the level 1 trauma centre between January 2011 and March 2014. Sixty two patients were included in the study. The mean patient age was (43.16 ± 11.59) years with 60 males and 2 females. Infectious complications like superficial and deep infection, wound dehiscence, malalignment in the immediate postoperative period and in follow-up period were noted.
The overall complication rate was 30.65% (19 out of 62). Infectious complications were noted in 20.97% cases (13/62). In majority of the cases (8/13), superficial infection was seen which managed with regular dressing and antibiotic administration. The patients (5/13) who had developed deep-seated infection were subjected to repeated debridements, flap coverage, implant removal or amputation depending upon the host response. Thirteen patients had experienced noninfectious complications. Hardware related complications were noticed in six patients and four among them received a secondary procedure. Malalignment was observed in seven patients but only single patient underwent subsequent operative intervention.
Proximal tibial plateau fractures especially Shatzker type V and VI are associated with extensive soft tissue damage even in closed injuries. The complications encountered in the management of these fractures can be minimized with appropriate patient selection and minimal soft tissue dissection.
报告复杂闭合性胫骨近端骨折治疗中的并发症。
进行一项回顾性研究，分析高能Schatzker V型和VI型胫骨平台骨折治疗中遇到的感染性和非感染性并发症。所有患者均于2011年1月至2014年3月在一级创伤中心接受治疗。62例患者纳入研究。患者平均年龄为（43.16±11.59）岁，其中男性60例，女性2例。记录了浅表和深部感染、伤口裂开、术后即刻及随访期间的畸形等感染性并发症。
总体并发症发生率为30.65%（62例中的19例）。20.97%的病例（13/62）出现感染性并发症。大多数病例（8/13）为浅表感染，通过定期换药和使用抗生素进行处理。发生深部感染的患者（5/13）根据宿主反应接受了反复清创、皮瓣覆盖、取出内固定或截肢。13例患者出现非感染性并发症。6例患者出现与内固定相关的并发症，其中4例接受了二次手术。7例患者出现畸形，但只有1例患者随后接受了手术干预。
胫骨近端平台骨折，尤其是Shatzker V型和VI型，即使在闭合性损伤中也伴有广泛的软组织损伤。通过适当的患者选择和最小限度的软组织剥离，可以将这些骨折治疗中遇到的并发症降至最低。
