Outpatient surgery for tibial plateau fractures

Area of Science:

• Orthopedic Surgery
• Trauma Surgery

Background:

• Tibial plateau fractures are complex injuries requiring surgical intervention.
• Open reduction and internal fixation (ORIF) is a common treatment.
• The safety and efficacy of outpatient ORIF for these fractures require further investigation.

Purpose of the Study:

• To evaluate the rates of compartment syndrome and other early complications in patients undergoing outpatient ORIF for tibial plateau fractures.
• To compare outcomes between outpatient and inpatient ORIF procedures.

Main Methods:

• Retrospective cohort study at a US level I academic trauma center.
• Included patients with operatively managed tibial plateau fractures, comparing inpatients and outpatients.
• Exclusion criteria for outpatient surgery included compartment syndrome, polytrauma, and open fractures.
• Primary outcome: post-operative compartment syndrome. Secondary outcomes: 90-day return to ED, readmission, infection, thromboembolism, and mortality.

Main Results:

• No cases of post-operative compartment syndrome were observed in either group.
• Intention-to-treat analysis showed no significant differences in 90-day readmission, ED visits, infection, DVT, or PE between inpatient and outpatient groups.
• As-treated analysis revealed significantly higher 90-day readmission and ED visit rates in the inpatient group.

Conclusions:

• Outpatient ORIF for appropriately selected isolated tibial plateau fractures is associated with non-inferior rates of compartment syndrome and post-operative complications compared to inpatient management.
• Ambulatory surgery may be a safe option for select patients with tibial plateau fractures.