[Importance of emergency temporary external fixation for bicondylar tibial plateau fractures : A 10-year retrospective analysis from a university level 1 trauma center].

Abstract

Background: Tibial plateau fractures (TPF) have significantly increased over the last decade, with a notable proportion being bicondylar fractures. The necessity of a temporary external fixator (tEF) as an initial treatment for bicondylar TPF remains controversial, with limited data available regarding associated complications.

Aim of the study: The aim of this study is to investigate the complication rates between patients with and without initial treatment using tEF in patients with bicondylar TPF.

Material and methods: This monocentric retrospective study analyzed the complication rates of bicondylar TPF from January 2011 to December 2020 at a university national trauma center. The bicondylar TPFs were divided into two groups based on the respective initial treatment: temporary external fixator (tEF, n = 67) and primary immobilization in brace/cast (iBC, n = 82). The complication rate was determined using univariate regression analysis.

Results: Overall, there was no significantly increased relative risk of complications between tEF and iBC (odds ratio, OR 1.97, 95% confidence interval, CI 0.90-4.37, p = 0.069). The specific complication of a postinterventional infection, however, was significantly more frequent with the use of tEF (OR 5.11, 95% CI 1.27-29.88, p = 0.01) but the use of tEF was not associated with an impaired range of motion (ROM).

Discussion: The overall postoperative complication rate for tibial plateau fractures is not influenced by the initial treatment with a temporary external fixator or a brace/cast. The decision for a tEF should be made individually and based on clear indications. The higher infection rate in patients with tEF represents a risk that must be considered in the context of potential bias related to more complex soft tissue and bone injuries as well as multiple injuries. Further studies are needed to validate these findings and provide further analysis to improve clinical decision making.