Complications and timing of soft tissue coverage after complete articular, open tibial plateau fractures

Phillip Grisdela Jr; Jeffrey Olson; Theodore Guild; Mihir Dekhne; Andrew Hresko; Upender M Singh; Michael J Weaver; Arvind von Keudell; Derek Stenquist

doi:10.1016/j.injury.2022.12.012

Complications and timing of soft tissue coverage after complete articular, open tibial plateau fractures

Injury. 2023 Feb;54(2):722-727. doi: 10.1016/j.injury.2022.12.012. Epub 2022 Dec 13.

Authors

Phillip Grisdela Jr¹, Jeffrey Olson², Theodore Guild², Mihir Dekhne³, Andrew Hresko², Upender M Singh⁴, Michael J Weaver³, Arvind von Keudell⁵, Derek Stenquist³

Affiliations

¹ Harvard Combined Orthopaedic Residency Program, 55 Fruit St, Boston MA 02114, United States. Electronic address: pgrisdela@bwh.harvard.edu.
² Harvard Combined Orthopaedic Residency Program, 55 Fruit St, Boston MA 02114, United States.
³ Harvard Orthopaedic Trauma Initiative, Boston MA 02114, United States.
⁴ Rigshospitalet, Department of Orthopedic Surgery, Copenhagen University, Denmark.
⁵ Harvard Orthopaedic Trauma Initiative, Boston MA 02114, United States; Bisbebjerg Hospital, University of Copenhagen, Denmark.

PMID: 36543739
DOI: 10.1016/j.injury.2022.12.012

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Flap coverage; Open fracture; Tibial plateau fracture; Trauma.

MeSH terms

Fracture Fixation, Internal
Fractures, Open* / surgery
Humans
Middle Aged
Retrospective Studies
Tibial Fractures* / surgery
Tibial Plateau Fractures*
Treatment Outcome