Grisdela Phillip, Olson Jeffrey, Guild Theodore, Dekhne Mihir, Hresko Andrew, Singh Upender M, Weaver Michael J, von Keudell Arvind, Stenquist Derek
Harvard Combined Orthopaedic Residency Program, 55 Fruit St, Boston MA 02114, United States.
Harvard Combined Orthopaedic Residency Program, 55 Fruit St, Boston MA 02114, United States.
Injury. 2023 Feb;54(2):722-727. doi: 10.1016/j.injury.2022.12.012. Epub 2022 Dec 13.
Complete articular tibial plateau fractures are typically high-energy injuries associated with significant soft tissue trauma. The primary aim of this study was to evaluate the incidence of wound complications and need for soft tissue coverage after open, complete articular tibial plateau fractures. The secondary aim was to study the effect of timing of fixation and timing of flap coverage on deep infection rates in these injuries.
This was a retrospective cohort study of consecutive patients > 18 years undergoing ORIF of a Bicondylar Tibial Plateau (BTP) fracture between 2001 and 2018. Surgical data were recorded for open fractures including number of debridements, timing of definitive ORIF and soft tissue coverage relative to injury. Primary outcomes included rates of deep infection and unplanned reoperation.
508 AO/OTA 41C BTP fractures were identified, with 51 open fractures included in 50 patients with a mean (SD) age 45.7 (12.3) years and a mean (SD) follow up of 4.3 (3.8) years. There were 20 cases of deep infection, unplanned reoperation occurred in 26 cases. The majority of cases (28 fractures) had initial external fixation placed, while 24 had ORIF at the initial debridement. Twelve patients had a planned flap for definitive closure on average of 6.4 days (SD 3.9) after injury, 14 required a flap for wound complications. Among patients with IIB and C injuries, rates of deep infection (5/6 vs 1/6, p = 0.02) and reoperation (5/7 vs 2/6, p = 0.08) were higher in patients treated with flap coverage >7 days from injury compared to early flap coverage. There were no differences in complication rates between early (<24hrs) and delayed fixation.
Complete articular, open tibial plateau fractures are associated with high rates of complications. Time to flap coverage of seven days or more was a significant predictor of deep infection and unplanned reoperation in this cohort. Patients should be counseled about the high rate of unplanned reoperation and definitive soft tissue coverage should be accomplished within a week of injury whenever possible.
胫骨平台完全关节内骨折通常为高能量损伤，常伴有严重的软组织创伤。本研究的主要目的是评估开放性胫骨平台完全关节内骨折后伤口并发症的发生率以及软组织覆盖的必要性。次要目的是研究固定时机和皮瓣覆盖时机对这些损伤深部感染率的影响。
这是一项回顾性队列研究，研究对象为2001年至2018年间接受双髁胫骨平台（BTP）骨折切开复位内固定术（ORIF）的18岁以上连续患者。记录开放性骨折的手术数据，包括清创次数、确定性ORIF的时机以及相对于损伤的软组织覆盖情况。主要结局包括深部感染率和非计划再次手术率。
共识别出508例AO/OTA 41C型BTP骨折，其中50例患者中有51例开放性骨折，平均（标准差）年龄45.7（12.3）岁，平均（标准差）随访4.3（3.8）年。发生深部感染20例，非计划再次手术26例。大多数病例（28例骨折）最初采用外固定，24例在初次清创时进行ORIF。12例患者计划进行皮瓣确定性闭合，平均在受伤后6.4天（标准差3.9）进行，14例因伤口并发症需要皮瓣。在IIB和C型损伤患者中，受伤后皮瓣覆盖时间>7天的患者与早期皮瓣覆盖的患者相比，深部感染率（5/6比1/6，p = 0.02）和再次手术率（5/7比2/6，p = 0.08）更高。早期（<24小时）固定和延迟固定的并发症发生率无差异。
胫骨平台完全关节内开放性骨折并发症发生率高。在本队列中，皮瓣覆盖时间7天或更长时间是深部感染和非计划再次手术的重要预测因素。应告知患者非计划再次手术率高，只要有可能，应在受伤后一周内完成确定性软组织覆盖。
