AI Article Synopsis
- This study investigates whether a single midline incision or dual medial/lateral incisions for dual plating of bicondylar tibial plateau fractures leads to different rates of deep infection and need for reoperation.
- The researchers analyzed data from 346 patients treated at two Level-1 trauma centers between 2001 and 2018, focusing on those with AO/OTA 41-C BTP fractures.
- Results showed no significant difference in infection or reoperation rates between the single incision and dual incision groups, but single plating via a single incision had lower complication rates compared to dual plating.
Article Abstract
Objectives: The use of one midline incision versus dual medial/lateral incisions for dual plating of bicondylar tibial plateau (BTP) fractures is controversial. This study aimed to compare rates of infection and secondary surgery in patients treated with dual plating for a BTP fracture using a single versus double incisions.
Design: Retrospective cohort study.
Setting: Two Level-1 trauma centers.
Patients/participants: Patients > 18 years with a closed AO/OTA 41-C BTP fracture without compartment syndrome treated with a single midline or dual incision (lateral with medial or posteromedial) approach for dual plating.
Intervention: Dual plating through either a single anterior incision, or dual medial/lateral incisions.
Main Outcome Measurements: Rates of deep infection and reoperation were compared using Chi-square analysis (p-value of < 0.05).
Results And Conclusions: In total 636 AO/OTA 41-C BTP fractures treated between 1/1/01 and 12/31/18 were identified and assessed. After exclusions for limited follow up, other techniques, open fracture and the need for fasciotomies, 346 patients were studied. Of these 254 had been treated with a single plate / single approach technique while 92 had been dual plated, 41 through a single anterior incision while 51 had dual plating through separate lateral and medial or posteromedial incisions. For these 92 fractures, there was no significant difference in the rate of deep infection (22.0% vs 23.5%, s=0.858) or reoperation (31.7% vs 31.4%, p=0.973) between the single and dual incision groups. Injuries that had been treated with single plating via a single incision had comparably lower rates of deep infection (10.2% vs. 22.8%, p=0.003) and reoperation (12.2% vs. 31.5%, p<0.001). There were no significant differences in any demographic parameters between patients undergoing single versus dual plating. Although retrospective, not randomized and subject to single surgeon bias these data suggest that these complications are more based on injury than the approach.
Level Of Evidence: III.
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| http://dx.doi.org/10.1016/j.injury.2022.07.037 | DOI Listing |
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