Presented: Yes
Presented at: OTA Annual Meeting 2015

Authors: Darryl Auston, MD/PhD; M Albanese, MD; Emil Azer, MD, R Bruce Simpson, MD
Author Affiliations: DA: OrthoOne, Thornton, CO; MA, EA: Upstate Ortho, Syracuse, NY; RBS: Trinity Health of New England, Hartford, CT

Introduction: The current recommendation for definitive treatment of displaced bicondylar tibial plateau fractures (AO/OTA 41C) is open reduction and internal fixation (ORIF) of both medial and lateral columns with dual plate fixation through two incisions. Use of a two-incision technique has been shown to reduce soft tissue complications associated with dual plating through a single anterior incision. We currently use a modified technique for initial stabilization wherein bicondylar tibial plateau fractures are treated with early posteromedial fixation at the time of provisional stabilization through a posteromedial incision (Figure 1). Our technique facilitates medial column reduction and converts an AO/OTA type 41C fracture to a 41B fracture. This report describes a retrospective comparison of surgical times and wound complications associated with patients treated with early “41C to 41B” technique and staged definitive fixation of the lateral column, and those treated with dual incision, dual plate fixation (DIDP) at the time of definitive fixation. We also compared time to definitive ORIF and length of hospital stay.

Methods / Materials: Consecutive AO/OTA 41C type fractures in presenting to a level 1 trauma center in a 8 year period were included for review (Figure 2). All patients were treated by two trauma fellowship trained surgeons with the either the 41C to 41B technique as described below, or through a DIDP fixation as previously described. Patient records were reviewed for total surgical time and wound complications.

Results:

1. No difference in overall surgical time.
2. No difference in time to definitive fixation or total hospital days.
3. Each study group had one superficial wound complication and one deep infection requiring surgical debridement. There was no statistical difference between the two study groups (p=0.20).

Discussion / Conclusion: The clinical evidence in this study shows that there is no significant disadvantage when using the 41C to B technique for closed bicondylar tibial plateau fractures with respect to wound complications, total operative time, time to definitive fixation, and length of hospital stay. Whereas we do not advocate universal application of this staged technique to all bicondylar tibial plateau fractures, we have found this technique to be an advantageous and safe adjunct to traditional approaches.