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

Abstract

To investigate whether an acute fixation protocol for high-energy tibial plateau fractures increases the rate of wound complications. Retrospective comparative study. Urban level 1 trauma centerPatients/Participants: 134 patients with high-energy tibial plateau fractures (OTA/AO 41B/C [Schatzker VI/V/VI]) treated with open reduction and internal fixation (ORIF). Utilization of an acute ORIF (<48 hours) versus delayed ORIF (>7 days) protocol. Primary outcomes: wound complications (wound dehiscence/necrosis, superficial/deep infections) and reoperations. Secondary outcomes: total operative costs and hospital length of stay (LOS). 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 -1,661.00; p<0.001) and hospital LOS (MD -4.0 days, CI -6.0 to 1.0; p=0.001). On multivariate analysis, wound complications were associated with increasing age (odds ratio (OR) 1.05, CI 1.01 to 1.10; p=0.01) and tobacco use (OR 3.75, CI 1.19 to 11.82; p=0.02). 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.