The Orthoplastic Approach for the Management of Early Postoperative Infections of Tibial Plateau Fractures

The orthoplastic approach enables simultaneous treatment of soft tissues and fracture. The aim of the present study was to report the results of patients who received orthoplastic treatment for early postoperative infection after osteosynthesis of tibial plateau fractures.

From 2008 to 2018, 17 patients underwent orthoplastic surgery for early postoperative infection after internal fixation of tibial plateau fractures in our center. The median time from internal fixation to re-operation was seven weeks (4-10). Tissue cultures and sonication fluid cultures of implants were obtained. In all cases, circular external fixation was used. Soft-tissues were covered with either the medial head of gastrocnemius along with split-skin graft (13 patients) or local advancement flaps (four patients). Postoperatively, antibiotics were administered based on antimicrobial susceptibility testing. At follow-up, clinical and radiologic examination was performed to assess wound healing and fracture union.

Circular external fixation was used for continuation of fracture stabilization in 14 patients and for knee arthrodesis due to severely damaged articular surfaces in two patients. One case was treated with anterior tibia bone transport. In all cases, bone union was achieved and skin was healed completely. SF-36 results at three years postoperatively were 61.29 ± 12.38 for the physical health component and 68.15 ± 13.34 for the mental health component.

In the right setting and with the required expertise, single stage orthoplastic treatment is a valid option that spares the patient from the distress of multiple procedures and offers acceptable clinical outcomes.