gms | German Medical Science

Objectives: Complex tibial plateau fractures (TPF) are a common type of injury caused by high-energy trauma. External fixation (EF) is a treatment strategy for temporary stabilization in acute situations. The indication for this treatment is not clearly specified. The aim of this study was to evaluate the complication rate of initial treatment by external fixator and to detect risk factors to increase patient care.

Methods: This retrospective single center study includes all surgically treated bicondylar TPF between January 2011 and December 2020 in a level I trauma center in Central Europe. The study population consists of 149 patients, of which 67 (45%) were treated with EF. The overall complication rate and the most common complications were recorded and analyzed.

Results and conclusion: The overall complication rate for the population was 35.57% (52/149).For EF the rate was 40.3% (27/67). Univariate regression analysis revealed that overall complications (odds ratio (OR) 1.97, 95% CI 0.90–4.37, p=n.s.) was not significantly increased for EF. Compartment syndrome (OR 1.22, 95% CI 0.01–97.43, p=n.s.), wound healing disorders (OR 0.60, 95% CI 0.05–4.35, p=n.s.) and structural defects (OR 3.54, 95% CI 0.80–21.60, p=n.s.) showed no significant differences. Also, the range of motion (OR 0, 95% CI 0–2.94, p=n.s.) and postoperative instability (OR 0.23, 95% CI 0.01–2.17, p=n.s.) showed no significant difference. Infections showed significant association with the use of EF (OR 5.11, 95% confidence interval (CI) 1.27–29.88, p<0,01). There was a significantly longer time between accident and definitive osteosynthetic treatment in the EF group, with a mean of 18±29 days, compared to 11±12 days in the other group. The age difference was statistically significant but numerically it was only one year (53.7±15.7 EF, 54.8±15.3 no EF).

This study found no superiority of initial treatment with EF or brace in complex TPF. The odds of complications are equal to lower with the use of EF, but there is also no superiority in terms of developing a compartment syndrome or wound healing complications. For the increased infection rate, it must be considered that treatment with EF was performed in cases of critical soft tissues or severely injured patients. In conclusion, the use of EF is not superior but also not worse than Knee brace. It remains unclear, whether the use of EF is needed. The indication for initial treatment by EF in bicondylar TPF remains an individual decision and is not required routinely.