Staged minimally invasive plate osteosynthesis of proximal tibial fractures with acute compartment syndrome.
OBJECTIVE
High-energy proximal tibial fractures often accompany compartment syndrome and are usually treated by fasciotomy with external fixation followed by secondary plating. However, the initial soft tissue injury may affect bony union, the fasciotomy incision or external fixator pin sites may lead to postoperative wound infections, and the staged procedure itself may adversely affect lower limb function. We assess the results of staged minimally invasive plate osteosynthesis (MIPO) for proximal tibial fractures with acute compartment syndrome.


METHODS
Twenty-eight patients with proximal tibial fractures accompanied by acute compartment syndrome who underwent staged MIPO and had a minimum of 12 months follow-up were enrolled. According to the AO/OTA classification, 6 were 41-A, 15 were 41-C, 2 were 42-A and 5 were 42-C fractures; this included 6 cases of open fractures. Immediate fasciotomy was performed once compartment syndrome was diagnosed and stabilization of the fracture followed using external fixation. After the soft tissue condition normalized, internal conversion with MIPO was done on an average of 37 days (range, 9-158) after index trauma. At the time of internal conversion, the external fixator pin site grades were 0 in 3 cases, 1 in 12 cases, 2 in 10 cases and 3 in 3 cases, as described by Dahl. Radiographic assessment of bony union and alignment and a functional assessment using the Knee Society Score and American Orthopedic Foot and Ankle Society (AOFAS) score were carried out.


RESULTS
Twenty-six cases achieved primary bony union at an average of 18.5 weeks. Two cases of nonunion healed after autogenous bone grafting. The mean Knee Society Score and the AOFAS score were 95 and 95.3 respectively, at last follow-up. Complications included 1 case of osteomyelitis in a patient with a grade IIIC open fracture and 1 case of malunion caused by delayed MIPO due to poor wound conditions. Duration of external fixation and the external fixator pin site grade were not related to the occurrence of infection.


CONCLUSIONS
Staged MIPO for proximal tibial fractures with acute compartment syndrome may achieve satisfactory bony union and functional results, while decreasing deep infections and soft tissue complications.
Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea.
Joon-Woo
JW
Kim
Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea. Electronic address: cwoh@knu.ac.kr.
Chang-Wug
CW
Oh
Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Republic of Korea.
Jong-Keon
JK
Oh
Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea.
Hee-Soo
HS
Kyung
Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea.
Kyeong-Hyeon
KH
Park
Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea.
Hee-June
HJ
Kim
Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea.
Jae-Wook
JW
Jung
Department of Orthopaedic Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea.
Young-Soo
YS
Jung
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D003161:Compartment Syndromes / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016267:External Fixators; D000071938:Fasciotomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011446:Prospective Studies; D011859:Radiography; D020127:Recovery of Function; D017695:Soft Tissue Injuries / Q000382:microbiology / Q000628:therapy*; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013978:Tibial Fractures / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
Compartment syndrome; Minimally invasive plate osteosynthesis; Proximal tibial fracture; Staged procedure