Abstract
PurposeTo analyze the cause of failure of the primary surgery for complex tibial plateau fractures and to define the therapeutic strategy of the revision surgery for the same.MethodsTwenty-one cases with failure of primary surgery for complex tibial plateau fractures were treated in our hospital from January 2012 to September 2016. There were 13 males and 8 females with an average age of 39.4 years (ranged between 27 and 58 years). Patients presented with different types of complex tibial plateau fractures like Schatzker type V (n=9), VI (n=12), type 41.C1 (n=9), type 41.C2 (n=6), and type 41.C3 (n=6). The therapeutic strategy for revision surgery in individual patients was decided following careful analysis and accurate assessment of the causes of failure of the primary surgery. All the patients were followed-up with Rasmussen radiographic scores and Hospital for Special Surgery (HSS) knee scores.ResultsAll 21 patients underwent clinical and radiological examination after a mean follow-up time of 32.6 months. The average time of fracture healing was 4.5 months (ranged between 3 and 6 months). During the last follow-up, the mean range of motion of knee extension was 2.3° and knee flexion was 123.8°. The mean radiological Rasmussen score was 15.6 points, with an overall success rate of 85.7%. The average HSS knee score was 84.3 points, with an overall success rate of 80.9%.ConclusionThe common reasons for the failure of primary surgery of complex tibial plateau fractures were inadequate experience of the surgeon, inaccurate diagnosis and management, improper selection of implants, and poor surgical techniques. The key factors to succeed revision surgery were adequate preoperative evaluation, accurate intraoperative procedures, and proper postoperative rehabilitation.Level of evidenceLevel IV, case series, treatment study
Highlights
Tibial plateau fractures are common intra-articular fractures, accounting for 1–2% of all fractures and up to 8% of all fractures in the elderly population [1, 2]
This study aimed to summarize the experience and lessons learned from the failure of primary surgery, to explore the factors that need to be assessed before revision surgery, and to identify effective preventive measures to avoid surgical complications
According to the analysis and summary of the whole clinical and radiographic data of all patients, the causes of failure of primary surgery can be divided into three types and were as follows: faulty diagnosis and treatment (7 patients; 33.3%), inaccurate selection of implants (8 patients; 38.1%), and imperfect surgical techniques (6 patients; 28.6%)
Summary
Tibial plateau fractures are common intra-articular fractures, accounting for 1–2% of all fractures and up to 8% of all fractures in the elderly population [1, 2]. Fractures that have an impact on the function and stability of tibial plateau usually require surgery. The incidence of complex tibial plateau fractures is increasing worldwide, especially in developed countries, as they occur due to the result of high-energy trauma. The anatomy of the proximal tibia, combined with high-energy trauma, produces complex. Song et al Journal of Orthopaedic Surgery and Research (2019) 14:110 injury patterns that involve metaphyseal and articular comminution fractures, frequently leading to the loss of integrity of the soft tissue envelope. The degree of comminution of metaphysis and articular surface along with the severity of soft tissue injury reflects the energy transmitted to the bone, leading to unfortunate prognosis [6]
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