Risk Factors for Reoperation and Mortality After the Operative Treatment of Tibial Plateau Fractures in Ontario, 1996–2009

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Abstract

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.

Conclusions:

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

Level of Evidence:

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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