San Francisco Orthopaedic Residency Program, 450 Stanyan Street, San Francisco, CA, 94117, USA.
Hospital Quiron, Plaça d'Alfonso Comin, 7, Gràcia, 08023, Barcelona, Spain.
Eur J Orthop Surg Traumatol. 2024 Aug;34(6):3275-3280. doi: 10.1007/s00590-024-04067-6. Epub 2024 Aug 13.
The purpose of this study was to determine the rates of compartment syndrome and other early complications following outpatient open reduction and internal fixation (ORIF) of tibial plateau fractures.
This was a retrospective cohort at a single US level I academic trauma centre of patients with tibial plateau fractures managed operatively. Inpatients received their definitive ORIF during their index hospital stay and were admitted post-operatively following ORIF. Outpatients were scheduled for ambulatory surgery during definitive ORIF. Exclusion criteria for outpatient surgery included compartment syndrome, polytrauma, open types IIIb/IIIc, and patients who received any internal fixation during index presentation. The primary outcome measure was post-operative compartment syndrome. Secondary outcomes were return to the 90-day return to the ED, 90-day readmission, surgical wound infection, thromboembolism, and 90-day mortality. An intention-to-treat (ITT) and as-treated (AT) analyses were performed.
Totally, 71 inpatients and 47 outpatients were included. There were no cases of post-operative compartment syndrome. In the ITT analysis, there were no differences for inpatients vs outpatients for 90-day re-admission (22.5% vs 12.8%, p = 0.275), 90-day return to the ED (35.2% vs 17.0%, p = 0.052), infection (12.7% vs 2.1%, p = 0.094), DVT (7% vs 4.3%, p = 0.819), or PE 1.4% vs 0.0%, p = 1.000). The AT analysis showed a significantly higher 90-day re-admission (26.9% vs 2.5%, p = 0.003) and 90-day ED visit (38.5% vs 7.5%, p = 0.001) rate in the inpatient group.
Appropriately selected patients with isolated tibial plateau fractures can have non-inferior rates of compartment syndrome and post-operative complications when compared to inpatients.
本研究旨在确定门诊切开复位内固定（ORIF）治疗胫骨平台骨折后的骨筋膜室综合征及其他早期并发症的发生率。
这是美国一家一级学术创伤中心的一项回顾性队列研究，纳入了接受手术治疗的胫骨平台骨折患者。住院患者在住院期间接受确定性 ORIF，并在接受 ORIF 后接受住院治疗。门诊患者在确定性 ORIF 期间接受日间手术。门诊手术的排除标准包括骨筋膜室综合征、多发伤、IIIb/IIIc 型开放性骨折，以及在就诊时接受任何内固定的患者。主要结局指标是术后骨筋膜室综合征。次要结局指标包括在 90 天内返回急诊部（ED）、90 天内再入院、手术部位感染、血栓栓塞和 90 天内死亡率。进行意向治疗（ITT）和实际治疗（AT）分析。
共纳入 71 例住院患者和 47 例门诊患者。均未发生术后骨筋膜室综合征。在 ITT 分析中，住院患者与门诊患者在 90 天内再入院（22.5%比 12.8%，p=0.275）、90 天内返回 ED（35.2%比 17.0%，p=0.052）、感染（12.7%比 2.1%，p=0.094）、DVT（7%比 4.3%，p=0.819）或 PE（1.4%比 0.0%，p=1.000）方面无差异。AT 分析显示，住院组的 90 天内再入院（26.9%比 2.5%，p=0.003）和 90 天内 ED 就诊（38.5%比 7.5%，p=0.001）率显著更高。
当与住院患者相比，适当选择的孤立性胫骨平台骨折患者可具有非劣效的骨筋膜室综合征和术后并发症发生率。
