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European Journal of Trauma and Emergency Surgery
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18-12-2023 | Tibial Plateau Fracture | Original Article

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

Authors: 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, José Vicente Andrés-Peiró

Published in: European Journal of Trauma and Emergency Surgery | Issue 3/2024

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Abstract

Purpose

Despite 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.

Methods

A 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.

Results

Sixty-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.

Conclusions

Staged 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.
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Metadata
Title
Staged treatment of bicondylar tibial plateau fractures: influence of frame configuration and quality of reduction on outcomes
Authors
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
José Vicente Andrés-Peiró
Publication date
18-12-2023
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 3/2024
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-023-02411-9

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