Is "Early Total Care" a Safe and Effective Alternative to "Staged Protocol" for the Treatment of Schatzker IV–VI Tibial Plateau Fractures in Patients Older Than 50 Years?. Issue 12 (December 2017)

• Record Type: Journal Article
• Authors: Borade, Amrut; Kempegowda, Harish; Richard, Raveesh; Graham, Jove; Suk, Michael; Horwitz, Daniel S.
• Is Part Of: Journal of orthopaedic trauma. Volume 31:Issue 12(2017)
• Publication Date: 2017-12
• Subjects: Early Total Care -- Staged Protocol -- external fixation -- soft tissue complications -- > 50 years; Orthopedics -- Periodicals; Wounds and injuries -- Periodicals; Orthopedics -- Periodicals; Wounds and Injuries -- therapy -- Periodicals; Periodicals; 617.47044
• DOI: 10.1097/BOT.0000000000000995
• Languages: English
• ISSNs: 0890-5339

Abstract

Abstract : Objectives: To compare "Early Total Care" (ETC) with "Staged Protocol" (SP) for the treatment of Schatzker IV–VI tibial plateau fractures in patients older than 50 years regarding safety and effectiveness. Design: Retrospective cohort study. Setting: An academic level 1 US trauma center. Patients/Participants: Eighty-one patients older than 50 years with Schatzker grade IV–VI tibial plateau fractures were included. Intervention: Fifty-three patients were treated under SP with immediate external fixation followed by definitive internal fixation. Twenty-eight patients were treated under ETC with immediate internal fixation. Main Outcome Measurements: Comparison of perioperative findings, time to bony and clinical union, soft-tissue and bony complications, radiological outcome, and secondary procedures. Results: The 2 groups were comparable without significant difference regarding age, sex, side of involvement, body mass index, smoking status, American Society of Anesthesiologist classification, associated injuries, comorbidities, follow-up duration, and fracture classification. No statistically significant difference was found regarding the perioperative complications, quality of reduction, time to union, Rasmussen score at union or at the final follow-up, soft-tissue/bony complications, and the rate of the secondary procedures. Conclusion: ETC seems to be a safe, efficacious, and effective alternative to the SP for the treatment of some Schatzker IV–VI fractures in patients older than 50 years. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.