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?

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Abstract

Objectives:

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.

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