Treatment Outcomes of Delayed Definitive Surgery of Tibial Plateau Fractures

Abstract

Background: Low energy tibia plateau fractures can be treated with definitive surgery within 48 hours. High energy tibia plateau fractures require a staged treatment plan that allows healing of the soft tissue envelope, with avoidance of devastating complications such as compartment syndrome and chronic infection. The aim of this study was to compare outcomes of definitive tibial plateau surgery performed within 21 days from the date of injury to those done after 21 days in a resource-restricted center. Methods: A retrospective cohort study was conducted. Group A consisted of patients that received their definitive surgery within 21 days of the injury. Group B were those who had definitive surgery after 21 days from the injury. Outcomes of interest included infectious complications (suggestive- and confirmed-fracture related infection (FRI)) and clinical outcomes (pain and range of motion). All patients were treated in one center between June 2018 and June 2020. Results: Forty-four (44) patients were included in the study. Twenty-three patients (23) were in group A while 21 were in group B. The median age was 40 (Inter quartile range [IQR]: 36 - 49) years in group A and 37 (IQR: 30 - 49) years in group B. Group A consisted of 15 males and 8 females while group B had 8 males and 13 females. Suggestive FRI rate in group A was 26% compared to 33% in group B. Confirmed FRI occurred in 2% of patients in group A compared to none in group B. The pain visual analogue scale (VAS) in group A had a median of 2 (IQR: 0 - 4) and 3 (IQR: 1 - 3) in group B. Range of motion was found to be 94.13 (range: 40 - 130) degrees on average for group A and 99.5 (range: 70 - 120) degrees for group B. Conclusion: Outcomes of surgeries performed after a delayed period of 21 days still were comparable to those performed before 21 days.