• Michael R Ruffolo, Franklin K Gettys, Harvey E Montijo, Rachel B Seymour, and Madhav A Karunakar.
• Department of Orthopaedic surgery, Carolinas Medical Center, Charlotte, NC.
• J Orthop Trauma. 2015 Feb 1;29(2):85-90.

ObjectivesTo characterize the rate of complications after operative fixation of bicondylar (OTA/AO 41-C) tibial plateau fractures and to evaluate the contribution of common risk factors.DesignRetrospective review.SettingLevel 1 regional trauma center.Patients/ParticipantsOne hundred thirty-eight patients older than 18 years with 140 bicondylar tibial plateau fractures were participated in this study.InterventionOpen reduction and internal fixation using medial and lateral plate construct through 2 incisions.Main Outcome MeasurementsDevelopment of a deep infection or a nonunion.ResultsThe overall major complication rate was 27.9%: 23.6% deep infection and 10.0% nonunion. Open fractures were associated with a higher rate of infection: 43.8% versus 21.0% for closed injuries (odds ratio = 2.96, P = 0.05). Fasciotomy closure before definitive fixation was associated with significantly fewer deep infections compared with internal fixation with open fasciotomy wounds: 11.8% versus 50.0% (odds ratio = 7.5, P = 0.05). The presence of compartment syndrome, tobacco use, diabetes, and timing of surgery had no statistically significant association on the rate of infection or nonunion.ConclusionsNonunion and deep infections occur commonly after staged open reduction and internal fixation of high-energy tibial plateau fractures. Open fractures and open fasciotomy wounds at the time of internal fixation are associated with higher rates of infection.Level Of EvidenceTherapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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