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

Objectives: To investigate whether an acute fixation protocol for high-energy tibial plateau fractures increases the rate of wound complications. Design: Retrospective comparative study. Setting: Urban level 1 trauma center. Patients/Participants: One hundred thirty-four patients with high-energy tibial plateau fractures (OTA/AO 41B/C [Schatzker VI/V/VI]) treated with open reduction and internal fixation (ORIF). Intervention: Utilization of an acute ORIF (<48 hours) versus delayed ORIF protocol. Main Outcome Measure: Primary outcomes: wound complications (wound dehiscence/necrosis, superficial/deep infections) and reoperations. Secondary outcomes: total operative costs and hospital length of stay. Results: Overall, 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 −1661.00; P < 0.001) and hospital length of stay (MD 4.0 days, CI, 6.0–1.0; P = 0.001). On multivariate analysis, wound complications were associated with increasing age (odds ratio (OR) 1.05, CI, 1.01–1.10; P = 0.01) and tobacco use (OR 3.75, CI, 1.19–11.82; P = 0.02). Conclusion: 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. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.