An Efficacy Analysis of Surgical Timing and Procedures for High-Energy Complex Tibial Plateau Fractures

摘要

Objective: To identify the most effective treatment for application to high-energy complex plateau fractures.Methods: 125 patients with closed high-energy complex tibial plateau fractures who had been surgically treated between 2003 and 2010 were reviewed retrospectively. Five procedure methods were studied (e.g. four open reduction and internal fixations, and close reduction via a minimal incision with hybrid external fixation) in five surgical timings, with a control group. The incidence of wound complications after operative treatment in the five surgical timings and the clinical effects of the five surgical procedure options were evaluated statistically. A postoperative follow-up ranging 26-110 months (mean, 36.5 months) was performed.Results: Among the various groups, the respective overall wound complication incidences were 20.0%, 41.6%, 33.3%, 2.5%, and 16.7% within 4 hours, 4 hours to 3 days, 3-5 days, 5-8 days, and more than 8 days after injury. Failed fixation was clearly observed in Group 1 (23.1%, 6/26) and Group 5 (21.7%, 5/23) (P < 0.05). Significant differences were also found among Group 2 (92.6%), Group 3 (93.3%), and Group 5 (69.6%), in terms of the good and excellent rate of joint function according to the Rasmussen score (P < 0.05).Conclusion: The optimal surgical timing is within 4 hours after trauma, for which no obvious swelling was observed in the limbs. This is followed by surgical timing within 5-8 days, after which trauma showed only subsided limb swelling. Dual plating provides the best stabilization option, as it allows early joint mobilization, cartilage regeneration, and joint remodeling, thus decreasing the risk of joint stiffness. Hybrid external fixation may provide relative stability to maintain fracture alignment without the need for massive soft tissue dissection, and also minimizes blood loss and potential soft tissue complications.