Risk Factors for Reoperation and Mortality After the Operative Treatment of Tibial Plateau Fractures in Ontario, 1996–2009. Issue 4 (April 2015)

• Record Type: Journal Article
• Authors: Henry, Patrick; Wasserstein, David; Paterson, Michael; Kreder, Hans; Jenkinson, Richard
• Is Part Of: Journal of orthopaedic trauma. Volume 29:Issue 4(2015)
• Publication Date: 2015-04
• Subjects: tibial plateau fracture -- reoperation -- cohort -- mortality -- trauma; Orthopedics -- Periodicals; Wounds and injuries -- Periodicals; Orthopedics -- Periodicals; Wounds and Injuries -- therapy -- Periodicals; Periodicals; 617.47044
• DOI: 10.1097/BOT.0000000000000237
• Languages: English
• ISSNs: 0890-5339

Abstract

Abstract : Objective: To define the rates and risk factors for reoperation and early mortality after open reduction and internal fixation (ORIF) of a tibial plateau fracture (AO type 41A–C) with or without concomitant tibial shaft fractures. Design: Retrospective cohort study of administrative health data (prognostic level II). Setting: Ontario, Canada. Patients/Participants: Eight thousand four hundred twenty-six patients who underwent unilateral tibial plateau ORIF between 1996 and 2009. Intervention: ORIF of the tibial plateau. Main Outcome Measures: Reoperation included irrigation and debridement, compartment syndrome release, amputation, knee fusion, implant removal, and repeat ORIF within 1 year of the index surgery and 90-day mortality. Outcomes were fit to a multivariate logistic regression model that included patient demographics, surgical factors, and provider factors as covariates. Results: The median cohort age was 48 years, with 51.5% male sex. Of all included plateau fractures, 27.9% were bicondylar fractures and 4.8% were open fractures. The odds of undergoing a repeat ORIF were increased significantly by the presence of an open fracture [odds ratio (OR) = 1.8, 1.3–25], bicondylar fracture (OR = 1.4, 1.2–1.7), an associated tibial shaft fracture (OR = 1.8, 1.3–2.5), surgery performed during the evening/weekend (OR = 1.24, 1.05–1.47), or surgery performed after midnight (OR = 2.08, 1.42–3.06). The odds of requiring an irrigation and debridement were also increased significantly by open fractures, bicondylar fractures, use of a temporizing external fixator, and an associated tibial shaft fracture [OR = 3.2 (2.2–4.6), 2.7 (2.1–3.5), 1.97 (1.09–3.56), and 3.2 (2.2–4.6), respectively]. The odds of repeat ORIF were significantly lower [0.8 (0.7–0.9)] when the index operation was performed in an academic center. Ninety-day mortality was 0.85% overall but 8.2% in patients older than 80 years. Conclusions: Markers of higher energy injury are associated with higher reoperation rates and 90-day mortality after ORIF of the tibial plateau. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence. Abstract : Supplemental Digital Content Is Available in the Text.