title: Is Early Definitive Fixation of Bicondylar Tibial Plateau Fractures Safe? An Observational Cohort Study.
abstract: OBJECTIVE
  The optimal treatment protocol for bicondylar plateau fractures remains controversial. Contrary to popular practice which favors a staged protocol in many high-energy fracture patterns, we have used early single-stage open reduction and internal fixation (ORIF) to treat these injuries whenever possible. The purpose of this study was to determine the complication rate and the functional and radiographic outcomes of this strategy.
  
  
  METHODS
  Retrospective cohort study and prospective data collection.
  
  
  METHODS
  Level I trauma center.
  
  
  METHODS
  One hundred one patients with 102 OTA/AO type 41-C bicondylar tibial plateau fractures were treated with early definitive ORIF, defined as nonstaged surgery performed within 72 hours from injury. A subset of patients was part of a longitudinal study and reported functional outcomes at 1 year.
  
  
  METHODS
  Early definitive ORIF.
  
  
  METHODS
  Primary outcome: reoperation rate, defined as any surgery within 12 months after the index operation; secondary outcomes: quality and stability of radiographic fracture reduction; and functional outcome [Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and short musculoskeletal functional assessment (SMFA)].
  
  
  RESULTS
  Nonstaged operative treatment of bicondylar plateau fractures was performed in 91.3% of the fractures during the study period. For those, early definitive ORIF (surgery within 72 hours from injury) was performed in 82.3% fractures. Mean time from injury to ORIF, for closed fractures, was 29.8 hours. Sixteen (15.7%) fractures, which were treated with early definitive ORIF, required an additional surgical procedure within 12 months. Complications included wound infection requiring surgical management, compartment syndrome requiring fasciotomies, nonunion, early fixation failure, and implant removal for discomfort. The reoperation rate was 12.7% if implant removal was excluded. At least 3 of the 4 radiographic criteria used to assess the adequacy of reduction were achieved in 95.1% of cases, and all 4 criteria were met in 59.8% of fractures. The Physical Component of the SF-36 at 12 months was 42.6, which is comparable to values reported in previous studies for operative treatment of bicondylar plateau fractures.
  
  
  CONCLUSIONS
  In a model where surgery is performed without delay by experienced orthopaedic trauma surgeons, a large proportion of bicondylar tibial plateau fractures can be safely treated with early definitive ORIF. Early surgery was associated with satisfactory postoperative radiographic reductions.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedics, Division of Orthopaedic Trauma, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Florence
authors.initials: F
authors.lastname: Unno
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Lefaivre
authors.forename: Georg
authors.initials: G
authors.lastname: Osterhoff
authors.forename: Pierre
authors.initials: P
authors.lastname: Guy
authors.forename: Henry M
authors.initials: HM
authors.lastname: Broekhuyse
authors.forename: Piotr A
authors.initials: PA
authors.lastname: Blachut
authors.forename: Peter
authors.initials: P
authors.lastname: OʼBrien
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D005593:Fracture Fixation, Internal; D017102:Fracture Healing; D007718:Knee Injuries / Q000453:epidemiology / Q000601:surgery; D008137:Longitudinal Studies; D011183:Postoperative Complications; D020127:Recovery of Function; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D055502:Secondary Prevention; D013978:Tibial Fractures / Q000453:epidemiology / Q000601:surgery; D016896:Treatment Outcome