title: Failure of fixation of tibial plateau fractures.
abstract: OBJECTIVE
  To define the failure of fixation in tibial plateau fractures, detect its incidence, and determine the contributing factors.
  
  
  METHODS
  Mail survey and literature review were used to define the fixation failure; this definition was applied to a radiologic review of patients who were treated surgically for tibial plateau fracture at a Level 1 trauma unit for a three-year period from 1993 to 1995.
  
  
  METHODS
  Forty-two consecutive patients treated surgically at our trauma unit for tibial plateau fractures were studied retrospectively, specifically for loss of fixation. Factors that might affect the fracture fixation were reviewed, including age, mechanism of injury, type of fracture, bone quality, severity of fragmentation, severity of displacement, time to surgery, operating time, fixation method, use of bone graft, postoperative bracing, and mobilization.
  
  
  METHODS
  The main outcome measure was failure of fixation, by using criteria defined by the result of a mail survey of experts and literature review.
  
  
  RESULTS
  Using a strict definition of radiologic failure of fixation, we reported an overall 31 percent rate of failure of fixation: 79 percent in patients older than sixty years compared with 7 percent in younger patients. The statistically significant associations with loss of reduction were age more than sixty years, premature weight bearing, preoperative displacement, fracture fragmentation, and severe osteoporosis.
  
  
  CONCLUSIONS
  It is logical to define failure of fixation using the same measures considered as indications for reduction and fixation. Using these strict criteria, the incidence of radiologic failure was much higher than previous published series. In the elderly this was unacceptably high, and treatment goals should be limited to restoring stability and alignment.
authors.affiliation: Department of Trauma and Orthopaedics, Manchester Royal Infirmary, Manchester, U.K.
authors.forename: Ahmad M
authors.initials: AM
authors.lastname: Ali
authors.forename: M
authors.initials: M
authors.lastname: El-Shafie
authors.forename: K M
authors.initials: KM
authors.lastname: Willett
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D005599:Fractures, Ununited / Q000503:physiopathology*; D006801:Humans; D007718:Knee Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000503:physiopathology; D011336:Probability; D011859:Radiography; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D017211:Treatment Failure