Is “Early Total Care” a Safe and Effective Alternative to “Staged Protocol” for the Treatment of Schatzker IV–VI Tibial Plateau Fractures in Patients Older Than 50 Years?
To compare “Early Total Care” (ETC) with “Staged Protocol” (SP) for the treatment of Schatzker IV–VI tibial plateau fractures in patients older than 50 years regarding safety and effectiveness.Design:
Retrospective cohort study.Setting:
An academic level 1 US trauma center.Patients/Participants:
Eighty-one patients older than 50 years with Schatzker grade IV–VI tibial plateau fractures were included.Intervention:
Fifty-three patients were treated under SP with immediate external fixation followed by definitive internal fixation. Twenty-eight patients were treated under ETC with immediate internal fixation.Main Outcome Measurements:
Comparison of perioperative findings, time to bony and clinical union, soft-tissue and bony complications, radiological outcome, and secondary procedures.Results:
The 2 groups were comparable without significant difference regarding age, sex, side of involvement, body mass index, smoking status, American Society of Anesthesiologist classification, associated injuries, comorbidities, follow-up duration, and fracture classification. No statistically significant difference was found regarding the perioperative complications, quality of reduction, time to union, Rasmussen score at union or at the final follow-up, soft-tissue/bony complications, and the rate of the secondary procedures.Conclusion:
ETC seems to be a safe, efficacious, and effective alternative to the SP for the treatment of some Schatzker IV–VI fractures in patients older than 50 years.Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.