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Olivieri R, Koch M, Laso J, Franulic N, Zanetta H. Predictive factors for infection after osteosynthesis of tibial plateau fractures: a retrospective study of 314 patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1831-1838. [PMID: 38427052 DOI: 10.1007/s00590-024-03856-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/08/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION The reported incidence of infection related with tibial plateau fractures (IRTPF) ranges from 2 to 23%. This complication can result in catastrophic consequences such as deformity, post-traumatic osteoarthritis, chronic pain, loss of function, and substantial economic burdens on healthcare systems due to extended hospital stays and the resources required for treatment. Consequently, it is imperative to emphasize the identification of infection risk factors. METHODS A retrospective case-control study was designed, encompassing patients who underwent surgery for tibial plateau fractures between 2015 and 2020. Frequencies and measures of central tendency were compared between infected patients (cases) and non-infected patients (controls) using rank-based statistical tests. Subsequently, two logistic regression models were employed to control for potential confounding variables. RESULTS A total of 314 patients were included, predominantly male (71.15%). Average age of 44.41 years. IRTPF were observed in 7.64% of the patients. In the univariate inferential statistical analysis, high-energy fractures (OR 6.35, p < 0.001), fractures with compartment syndrome (OR 7.10, p < 0.001), two-stage management with temporary external fixation (OR 8.18, p < 0.001), the use of 2 or more approaches in definitive surgery (OR 2.93, p = 0.011), and the use of two or more plates (OR 9.17, p < 0.001) were identified as risk factors for infection. On average, the duration of surgery in infected patients was 201.2 min, compared to 148.4 min in non-infected patients (p < 0.001). When performing two logistic regression models, the following independent risk factors were identified: high-energy fractures (OR 5.04, p = 0.012), the presence of compartment syndrome (OR 4.53, p = 0.007), and the use of two or more plates in definitive surgery (OR 5.04, p = 0.023). CONCLUSIONS High-energy tibial plateau fractures (Schatzker IV, V, and VI), the presence of concomitant compartment syndrome, and the use of 2 or more plates in definitive surgery are associated with a higher risk of infection related to fracture following open reduction and osteosynthesis treatment. LEVEL OF EVIDENCE Case-Control Study. LEVEL III EVIDENCE
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Affiliation(s)
- Rodrigo Olivieri
- Orthopedics Department, Knee Unit, Hospital del Trabajador ACHS, Ramón Carnicer 185, Providencia, Santiago, Chile.
| | - Marco Koch
- Orthopedics and Traumatology Resident, Universidad Andrés Bello, Santiago, Chile
| | - José Laso
- Orthopedics Department, Knee Unit, Hospital del Trabajador ACHS, Ramón Carnicer 185, Providencia, Santiago, Chile
- Hospital Barros Luco Trudeau, Santiago, Chile
| | - Nicolás Franulic
- Orthopedics Department, Knee Unit, Hospital del Trabajador ACHS, Ramón Carnicer 185, Providencia, Santiago, Chile
- Hospital Militar de Santiago, Santiago, Chile
| | - Hugo Zanetta
- Orthopedics and Traumatology Resident, Universidad Andrés Bello, Santiago, Chile
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Dobelle E, Fabre-Aubrespy M, Mandon B, Flecher X, Ollivier M, Argenson JN, Jacquet C. Bicondylar tibial plateau fracture osteosynthesis with double-plate fixation: Similar complication rates and clinical results but improved radiographic outcomes with dual compared to single approach. Orthop Traumatol Surg Res 2024; 110:103655. [PMID: 37423296 DOI: 10.1016/j.otsr.2023.103655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 12/30/2022] [Accepted: 05/16/2023] [Indexed: 07/11/2023]
Abstract
INTRODUCTION Associating posteromedial and anterolateral approaches should improve fracture line visualization and optimize bicondylar tibial plateau fracture reduction compared to a single midline approach. The present study aimed to compare postoperative complications rates and functional and radiographic results after double-plate fixation via either a single or a dual approach. The study hypothesis was that double-plate fixation using a dual approach provides equivalent complications rates with improved radiographic results compared to a single approach. MATERIAL AND METHODS A retrospective 2-center study compared bicondylar tibial plateau fractures treated by double-plate fixation on a single versus a dual approach between January 2016 and December 2020. Comparison focused on major complications requiring surgical revision, radiographic measurements of medial proximal tibial angle (MPTA) and posterior proximal tibial angle (PPTA); change from their respective baseline values of 87° and 83° (deltaMPTA and deltaPPTA), and functional results on KOOS, SF12 and EQ5D-3L self-reported questionnaires. RESULTS Major complications occurred in 2 of the 20 single approach group patients (10%) [1 surgical site infection (SSI) (5%), and 1 skin complication (5%)], and in 3 of the 39 dual approach group patients (7.69%) (p=0.763), at an average 29 months' follow-up. In the sagittal plane, deltaPPTA was significantly lower with dual than single approach (respectively, 4.67° versus 7.43°; p=0.0104). There were no significant intergroup differences in deltaMPTA or functional results at last follow-up. CONCLUSION The present study suggests an absence of significant difference in major complications, between single and dual approach for double-plate osteosynthesis of bicondylar tibial plateau fractures. Using a dual approach enabled improved anatomic restoration in the sagittal plane, without significant differences observed in the frontal plane or functional scores at an average 29months' follow-up. LEVEL OF EVIDENCE III; case-control study.
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Affiliation(s)
- Emile Dobelle
- Institut du Mouvement et de l'Appareil Locomoteur, Département d'Orthopédie et de Traumatologie ISM, CNRS, Aix-Marseille Université, Hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France.
| | - Maxime Fabre-Aubrespy
- Institut du Mouvement et de l'Appareil Locomoteur, Département d'Orthopédie et de Traumatologie ISM, CNRS, Aix-Marseille Université, Hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France
| | - Bastien Mandon
- Institut du Mouvement et de l'Appareil Locomoteur, Département d'Orthopédie et de Traumatologie ISM, CNRS, Aix-Marseille Université, Hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France
| | - Xavier Flecher
- Institut du Mouvement et de l'Appareil Locomoteur, Département d'Orthopédie et de Traumatologie ISM, CNRS, Aix-Marseille Université, Hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France; Institut du Mouvement et de l'Appareil Locomoteur, CHU Marseille Nord, chemin des Bourrely, 13015 Marseille, France
| | - Matthieu Ollivier
- Institut du Mouvement et de l'Appareil Locomoteur, Département d'Orthopédie et de Traumatologie ISM, CNRS, Aix-Marseille Université, Hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France
| | - Jean-Noël Argenson
- Institut du Mouvement et de l'Appareil Locomoteur, Département d'Orthopédie et de Traumatologie ISM, CNRS, Aix-Marseille Université, Hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France
| | - Christophe Jacquet
- Institut du Mouvement et de l'Appareil Locomoteur, Département d'Orthopédie et de Traumatologie ISM, CNRS, Aix-Marseille Université, Hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, BP 29, 13274 Marseille, France
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Hadinoto SA, Sumarwoto T, Sibarani T, Anwar IB, Saddalqous. Dealing with soft tissue compromised in tibial plateau fractures by using a hybrid external fixation. Int J Surg Case Rep 2023; 105:108105. [PMID: 37028185 PMCID: PMC10106473 DOI: 10.1016/j.ijscr.2023.108105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Tibial plateau fractures are often accompanied by soft tissue compromise, especially in Schatzker 5 and 6, caused by high-energy trauma. In this situation, more careful consideration is needed. A rush decision will result in morbidity, bad postoperative wounds, and infections resulting in dehiscence. CASE PRESENTATION We have three patients with the tibial plateau. In the first case, ORIF was still performed on the fracture with soft tissue compromised. The patient was found to have wound dehiscence resulting in an implant-exposed bone. In the subsequent two cases, Patients with tibial plateau Schatzker 6 fractures also showed blisters around their injured knees. We performed hybrid external fixation. Screwing fixation was performed to obtain compression. Kirschner wire 2.2 formed a raft configuration attached to the semicircular frame and uniplanar external fixation to support the tibial plateau. CLINICAL DISCUSSION A hybrid external fixation is an excellent option for treating tibia plateau fractures with compromised soft tissue. It can achieve early fracture fixation while avoiding soft tissue problems; thus, the patients can start early rehabilitation. CONCLUSION A hybrid external fixation can be applied to tibial plateau fractures with soft tissue compromised without waiting for subsiding and has satisfactory clinical and radiological outcomes. The author also explains this case report's hybrid external fixation technique.
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Gálvez-Sirvent E, Ibarzábal-Gil A, Rodríguez-Merchán EC. Complications of the surgical treatment of fractures of the tibial plateau: prevalence, causes, and management. EFORT Open Rev 2022; 7:554-568. [PMID: 35924649 PMCID: PMC9458943 DOI: 10.1530/eor-22-0004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Open reduction and internal fixation is the gold standard treatment for tibial plateau fractures. However, the procedure is not free of complications such as knee stiffness, acute infection, chronic infection (osteomyelitis), malunion, non-union, and post-traumatic osteoarthritis. The treatment options for knee stiffness are mobilisation under anaesthesia (MUA) when the duration is less than 3 months, arthroscopic release when the duration is between 3 and 6 months, and open release for refractory cases or cases lasting more than 6 months. Early arthroscopic release can be associated with MUA. Regarding treatment of acute infection, if the fracture has healed, the hardware can be removed, and lavage and debridement can be performed along with antibiotic therapy. If the fracture has not healed, the hardware is retained, and lavage, debridement, and antibiotic therapy are performed (sometimes more than once until the fracture heals). Fracture stability is important not only for healing but also for resolving the infection. In cases of osteomyelitis, treatment should be performed in stages: aggressive debridement of devitalised tissue and bone, antibiotic spacing and temporary external fixation until the infection is resolved (first stage), followed by definitive surgery with grafting or soft tissue coverage depending on the bone defect (second stage). Intra-articular or extra-articular osteotomy is a good option to correct malunion in young, active patients without significant joint damage. When malunion is associated with extensive joint involvement or the initial cartilage damage has resulted in knee osteoarthritis, the surgical option is total knee arthroplasty.
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Affiliation(s)
- Elena Gálvez-Sirvent
- Department of Orthopaedic Surgery, "Infanta Elena" University Hospital, Valdemoro, Madrid, Spain.,Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - Aitor Ibarzábal-Gil
- Department of Orthopaedic Surgery, "La Paz" University Hospital, Madrid, Spain
| | - E Carlos Rodríguez-Merchán
- Department of Orthopaedic Surgery, "La Paz" University Hospital, Madrid, Spain.,Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Autonomous University of Madrid), Madrid, Spain
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Obana KK, Lee G, Lee LS. Characteristics, Treatments, and Outcomes of Tibial Plateau Nonunions: A Systematic Review. J Clin Orthop Trauma 2021; 16:143-148. [PMID: 33717949 PMCID: PMC7920010 DOI: 10.1016/j.jcot.2020.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Due to the rare incidence of tibial plateau nonunions, current studies are limited to small sample sizes and patient demographics. The aim of this systematic review is to quantify and report patient and fracture traits, possible risk factors, and treatment outcomes of tibial plateau nonunions. METHODS PubMed, Clinical Key, and MEDLINE were searched for articles published prior to August 2020 in accordance to the preferred reporting items for systematic reviews and meta-analyses (PRISMA). The authors used varying combinations of the following terms to identify relevant articles: "tibial," "plateau," "nonunion," "non-union." Studies were assessed for patient demographics, pre-revision nonunion characteristics, treatment, and post-revision outcomes. RESULTS Eight studies were included, yielding 31 tibial plateau nonunions (21 males, 10 females). The majority of nonunions were associated with high energy trauma (52.2%) and were Schatzker class VI (54.8%). Schatzker class I and II nonunions were not attributed to neglect, contradicting previous suggestions. Time to union was 4.0 months, the most common treatments being autologous bone grafting (76.7%) and revision plating (63.3%). CONCLUSION This study demonstrates the effectiveness of autologous bone grafts and revision plating for tibial plateau nonunions. Physicians may use these findings to guide decision making in the event of high energy plateau nonunions. Lastly, various limitations exist within the current literature, emphasizing the need for standardized reporting measures.
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Affiliation(s)
- Kyle K. Obana
- Department of Orthopaedic Surgery, John A. Burns School of Medicine, 651 Ilalo St, Honolulu, HI, 96822, USA
| | - Gordon Lee
- Department of Orthopaedic Surgery, John A. Burns School of Medicine, 651 Ilalo St, Honolulu, HI, 96822, USA
| | - Lorrin S.K. Lee
- Department of Orthopaedic Surgery, John A. Burns School of Medicine, 651 Ilalo St, Honolulu, HI, 96822, USA
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Norris GR, Checketts JX, Scott JT, Vassar M, Norris BL, Giannoudis PV. Prevalence of Deep Surgical Site Infection After Repair of Periarticular Knee Fractures: A Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2:e199951. [PMID: 31441940 PMCID: PMC6714463 DOI: 10.1001/jamanetworkopen.2019.9951] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE Surgical management of periarticular knee fractures can be challenging, and adverse outcomes may be severe. Recent literature indicates that the rate of periarticular knee surgical site infection (SSI) may range from 2% to 88% depending on the fracture site. OBJECTIVE To examine the prevalence of deep SSI and the rate of septic arthritis after surgical repair of fractures around the knee. DATA SOURCES The electronic databases MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from their inception to July 1, 2018. STUDY SELECTION Eligible studies had to specifically report deep SSI rates and include fractures in the distal femur, patella, tibial plateau, or proximal tibia. Risk factors that were associated with increased the risk of deep SSI were also examined. DATA EXTRACTION AND SYNTHESIS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Data were extracted by multiple investigators. Comprehensive Meta-Analysis software was used for the pooling of data, using either random-effects or fixed-effects models, with respect to the degree of statistical heterogeneity present. Data analyses were conducted in October 2019. MAIN OUTCOMES AND MEASURES The primary outcome was overall prevalence of deep SSI after periarticular knee fracture repair. The secondary outcomes were the overall prevalence of septic arthritis, risk factors associated with deep SSI, and the most commonly cultured bacteria specimens found periarticular knee infections. RESULTS Of 6928 articles screened, 117 articles met inclusion criteria and were included in analysis. Among 11 432 patients included in analysis, 653 patients (5.7%) experienced deep SSIs, most commonly among patients with proximal tibia fractures (56 of 872 patients [6.4%]). Among studies that included information on septic arthritis, 38 of 1567 patients (2.4%) experienced septic arthritis. The 2 most commonly reported bacteria were methicillin-resistant Staphylococcus aureus, found in 67 SSIs, and methicillin-susceptible S aureus, found in 53 SSIs. Sixty-two studies (53.0%) in the sample received a Coleman Methodological Score of poor (<50 points). CONCLUSIONS AND RELEVANCE Deep SSIs occurred in nearly 6% of periarticular knee fracture repairs, and 2.4% of SSIs were associated with septic arthritis. Surgeons managing these injuries should be vigilant when wounds are not pristine. Efforts should be made to elevate the quality of research conducted not only in this subject but also in orthopedic surgery as a whole.
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Affiliation(s)
| | | | - Jared T. Scott
- Oklahoma State University Center for Health Sciences, Tulsa
- Department of Orthopedics, Oklahoma State University Center for Health Sciences, Tulsa
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences, Tulsa
| | - Brent L. Norris
- Department of Orthopedics, Oklahoma State University Center for Health Sciences, Tulsa
- Orthopedic & Trauma Services of Oklahoma, Tulsa
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Ilizarov Fixator Technique in Type V and VI Tibial Plateau Fractures: A Case Series. Trauma Mon 2018. [DOI: 10.5812/traumamon.67618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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