An Acute Fixation Protocol for High-Energy Tibial Plateau Fractures Decreases Time to Fixation and Lowers Operative Costs Without Affecting Wound Complications and Reoperations.

OBJECTIVES

To investigate whether an acute fixation protocol for high-energy tibial plateau fractures increases the rate of wound complications.

DESIGN

Retrospective comparative study.

SETTING

Urban level 1 trauma center.

PATIENTS/PARTICIPANTS: One hundred thirty-four patients with high-energy tibial plateau fractures (OTA/AO 41B/C [Schatzker VI/V/VI]) treated with open reduction and internal fixation (ORIF).

INTERVENTION

Utilization of an acute ORIF (<48 hours) versus delayed ORIF protocol.

MAIN OUTCOME MEASURE

Primary outcomes: wound complications (wound dehiscence/necrosis, superficial/deep infections) and reoperations. Secondary outcomes: total operative costs and hospital length of stay.

RESULTS

Overall, 83.9% (26/31) of patients received definitive fixation within 48 hours under the acute ORIF protocol versus 18.4% (19/103) of patients treated under the standard delayed protocol with no observed differences in the rate of wound complications (proportional difference (PD) -4.6%, confidence interval (CI) -17.2% to 11.3%; P = 0.78) or reoperations (PD 2.0%, CI, 13.0% to 12.5%; P = 1.00). The acute ORIF protocol lowered operative costs (median difference (MD) $-2.563.00, CI, 3021.00 to -1661.00; P < 0.001) and hospital length of stay (MD 4.0 days, CI, 6.0-1.0; P = 0.001). On multivariate analysis, wound complications were associated with increasing age (odds ratio (OR) 1.05, CI, 1.01-1.10; P = 0.01) and tobacco use (OR 3.75, CI, 1.19-11.82; P = 0.02).

CONCLUSION

An acute ORIF protocol for high-energy tibial plateau fractures decreased time to fixation and lowered operative costs without increasing the risk of wound complications or reoperations.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.