• Eur J Trauma Emerg Surg · Jun 2024

    Staged treatment of bicondylar tibial plateau fractures: influence of frame configuration and quality of reduction on outcomes.

    • Rafael Oleo-Taltavull, Sebastián Corró, Jordi Tomàs-Hernández, Jordi Teixidor-Serra, Jordi Selga-Marsà, Juan Antonio Porcel-Vázquez, Carlos Alberto Piedra-Calle, Yaiza García-Sánchez, Ernesto Melchor Guerra-Farfán, and José Vicente Andrés-Peiró.
    • Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
    • Eur J Trauma Emerg Surg. 2024 Jun 1; 50 (3): 103310411033-1041.

    PurposeDespite evolving treatment, the surgical management of high-energy tibial plateau fractures (TPF) remains challenging, associating high rates of complications. In recent decades, staged management has emerged as an encouraging option. The main goal of our study was to evaluate the influence of bridging external fixation (EF) frame configuration and the resultant quality of reduction (QOR) on outcomes after staged-treatment of bicondylar TPF.MethodsA retrospective review was conducted of patients with bicondylar TPF treated at our level-I trauma center using a staged-treatment protocol from January 2010 to January 2020. Data on baseline characteristics, injuries, treatments, and clinical/radiological results were collected. The QOR was evaluated on CT images after EF and on plain films after ORIF.ResultsSixty-eight patients were eligible for analysis. By our criteria, QOR was good in 57.4% and 70.6% after EF and ORIF, respectively. A squared EF configuration was associated with superior EF QOR (p = 0.032), while better EF QOR was linked to improved ORIF QOR (p = 0.016). No relationship between ORIF delay and ORIF QOR was identified. Postoperative complications were documented in 19 patients. Average ROM at one-year follow-up was 114.9 ± 12.6°, and non-influenced by anterior femoral pin placement.ConclusionsStaged management of bicondylar TPF resulted in a reasonable rate of complications. A direct relationship between QORs obtained with EF and after ORIF was found. Squared frames were associated with faster and better reductions, regardless of the surgeon's background. Considering our results, we advocate for the wider use of squared EF configurations in these patients.© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

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