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Risk factors for re-operation and mortality following the operative treatment of tibial plateau fractures in Ontario, 1996-2009

Henry P, Wasserstein D, Paterson M, Kreder H, Jenkinson R. J Orthop Trauma. 2014; 29(4):182-8. Epub 2014 Sep 17.

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.

Conclusion — Markers of higher energy injury are associated with higher re-operation rates and 90-day mortality after ORIF of the tibial plateau.

Keywords: Musculoskeletal and joint diseases Surgery