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Open Access 09-05-2024 | Tibial Plateau Fracture | Original Article

Subchondral rafting wires reduce tibial plateau fracture subsidence

Authors: Joseph T. Patterson, Daniel Rusu, Andrew M. Duong, Vivek Satish, Max Yang, Lucas Mayer, Michael Allen, Geoffrey S. Marecek

Published in: European Journal of Orthopaedic Surgery & Traumatology

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Abstract

Purpose

To determine if subchondral rafting wires retained as adjunctive tibial plateau fracture fixation affect postoperative articular subsidence.

Methods

A retrospective cohort study was conducted at one Level 1 trauma center and one academic university hospital. Consecutive adults with closed, displaced OTA/AO 41B/C tibial plateau fractures treated between 2018 and 2023 with open reduction internal fixation were included. Patients who were not ambulatory, with contralateral injuries limiting weight bearing, and without follow-up radiographs of the injured extremity were excluded. The intervention was retention of subchondral rafting wires as definitive fixation. The primary outcome was linear articular surface subsidence between postoperative and follow-up AP knee radiographs. Linear subsidence was compared between groups using Welch’s two sample t test. Associations of linear subsidence with patient, injury, and treatment characteristics were assessed by multivariable linear regression.

Results

We identified 179 patients of a mean age of 44 ± 14 years, of whom 15 (8.4%) received subchondral rafting wires. Median follow-up was 121 days. No patients who received rafting wires as definitive implants experienced linear subsidence ≥ 2 mm, while 22 patients (13.4%) who did not receive rafting wires experienced linear subsidence ≥ 2 mm (p = 0.130). Subchondral rafting wires were associated with less linear subsidence (0.3 mm [95% confidence interval − 0.3–0.9 mm] vsersus 1.0 mm [− 0.9–2.9 mm], p < 0.001). The depth of linear subsidence was significantly associated on multivariable regression with male sex, depressed plateau area, active smoking, and retained rafting wires.

Conclusion

Subchondral rafting wires were associated with a small reduction in articular subsidence after internal fixation of tibial plateau fractures. Routine rafting wires may be useful for patients and fractures at high risk of articular subsidence.
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Metadata
Title
Subchondral rafting wires reduce tibial plateau fracture subsidence
Authors
Joseph T. Patterson
Daniel Rusu
Andrew M. Duong
Vivek Satish
Max Yang
Lucas Mayer
Michael Allen
Geoffrey S. Marecek
Publication date
09-05-2024
Publisher
Springer Paris
Published in
European Journal of Orthopaedic Surgery & Traumatology
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI
https://doi.org/10.1007/s00590-024-03963-1