Harvard Medical School Orthopedic Trauma Initiative, Boston, MA.
Harvard Combined Orthopaedic Residency Program, Boston, MA.
J Orthop Trauma. 2022 Aug 1;36(8):382-387. doi: 10.1097/BOT.0000000000002334.
To compare the risk of deep infection and unplanned reoperation after staged open reduction internal fixation (ORIF) of bicondylar tibial plateau (BTP) fractures whether elements of the temporizing external fixator were prepped into the surgical field or completely removed before definitive fixation.
Retrospective comparative cohort study.
Two academic Level 1 trauma centers.
PATIENTS/PARTICIPANTS: One hundred forty-seven OTA/AO 41-C (Schatzker 6) BTP fractures treated with a 2-stage protocol of acute spanning ex-fix followed by definitive ORIF between 2001 and 2018.
Seventy-eight fractures had retained elements of the original ex-fix prepped in situ during surgery for definitive internal fixation, and 69 had the ex-fix construct completely removed before prepping and draping.
Deep infection and unplanned reoperation.
Among 147 patients treated with staged ORIF, the overall deep infection rate was 26.5% and the reoperation rate was 33.3%. There were high rates of deep infection (26.9% vs. 26.1%, P = 0.909) and unplanned reoperation (30.8% vs. 36.2%, P = 0.483) in both groups, but no difference whether the ex-fix was prepped in or completely removed. Within the retained ex-fix group, there was no difference in infection with retention of the entire ex-fix compared with only the ex-fix pins (28.1% vs. 26.1%, P = 0.842).
We observed high complication rates in this cohort of OTA/AO 41C BTP fractures treated with staged ORIF, but prepping in the ex-fix did not lead to a significant increase in rates of infection or reoperation. This study provides the treating surgeon with clinical data about a common practice used to facilitate definitive fixation of unstable BTP fractures.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
比较分期切开复位内固定（ORIF）治疗双髁胫骨平台（BTP）骨折时，临时外固定架的元件是否在准备进行确定性固定之前预置于手术野中或完全移除后，深部感染和计划外再次手术的风险。
回顾性比较队列研究。
两家学术性 1 级创伤中心。
患者/参与者：2001 年至 2018 年间，147 例 OTA/AO 41-C（Schatzker 6）BTP 骨折患者采用急性跨外固定架固定后分期手术的 2 期方案治疗。
78 例骨折患者在确定性内固定术中保留了原始外固定架的元件，而 69 例患者在准备和铺巾前完全移除了外固定架。
深部感染和计划外再次手术。
在接受分期 ORIF 治疗的 147 例患者中，总体深部感染率为 26.5%，再次手术率为 33.3%。两组深部感染率（26.9%比 26.1%，P=0.909）和计划外再次手术率（30.8%比 36.2%，P=0.483）均较高，但外固定架是否预置于手术野中并无差异。在外固定架保留组中，保留整个外固定架与仅保留外固定架钉相比，感染率无差异（28.1%比 26.1%，P=0.842）。
我们观察到接受分期 ORIF 治疗的 OTA/AO 41C BTP 骨折患者的并发症发生率较高，但在准备进行确定性固定时，外固定架的预置并不会显著增加感染或再次手术的发生率。本研究为治疗医生提供了关于一种常见的临床实践的数据，该实践用于促进不稳定 BTP 骨折的确定性固定。
治疗性 3 级。有关证据水平的完整描述，请参阅作者说明。
