Early Versus Delayed Definitive Fixation Relative to Fasciotomy Closure in High-Energy Tibial Plateau Fractures With...

Area of Science:

• Orthopedic surgery
• Trauma surgery
• Biomechanics

Background:

• Tibial plateau fractures (TPF) with compartment syndrome require timely management.
• The optimal timing for definitive fracture fixation relative to fasciotomy closure remains debated.
• Fasciotomy is crucial for managing compartment syndrome, but its timing relative to fracture fixation can impact outcomes.

Purpose of the Study:

• To compare the outcomes of early versus delayed fixation of tibial plateau fractures in patients with compartment syndrome.
• To evaluate the impact of fixation timing on articular reduction and limb alignment.
• To assess infection rates associated with different fixation timings relative to fasciotomy closure.

Main Methods:

• Retrospective case series involving 131 patients from four Level I trauma centers.
• Patients with TPF and compartment syndrome treated with fasciotomy were divided into early fixation (EF) and delayed fixation (DF) groups.
• Outcomes assessed included radiographic limb alignment, articular reduction, and infection rates.

Main Results:

• Early fixation (before or at fasciotomy closure) was associated with significantly higher rates of anatomic articular reduction (52.2% vs. 37.5%).
• The delayed fixation group had a 2.17 times higher relative risk of infection compared to the early fixation group.
• No significant differences were observed in fracture pattern distribution between the groups.

Conclusions:

• Fixation of tibial plateau fractures before or at the time of fasciotomy closure leads to better articular reduction.
• Performing definitive fixation after fasciotomy closure increases the risk of infection.
• Optimal timing of fixation relative to fasciotomy closure is critical for managing TPF with compartment syndrome.