Complications in Acute Versus Delayed Definitive Fixation of Bicondylar Tibial Plateau Fractures

Background: This study compared outcomes of bicondylar tibial plateau fractures treated with staged versus acute definitive fixation. Materials and Methods: A multicenter retrospective review at 3 academic level 1 trauma centers included adult patients treated surgically for bicondylar tibial plateau fractures, grouped by treatment strategy: staged fixation (external fixation followed by open reduction internal fixation [ORIF]) or acute ORIF within ≤72 hours, comparing quality of reduction and complications, including unplanned return to the operating room. Results: A total of 96 patients were treated with staged ORIF (group 1) and 74 with acute ORIF ≤72 hours (group 2). Length of stay was longer ( P = .011) and incidence of complication higher in group 1 (31% vs 14%; P = .013). Wound dehiscence and drainage were significantly higher in group 1; concomitant compartment syndrome and wound vacuum-assisted closure were also highest in this group. There were no differences in AO/OTA classification across groups ( P = .13); however, more complex fractures were associated with infection ( P = .026) and longer delays to definitive surgery ( P = .046). Quality of reduction was similar between groups. Patients in group 2 were less frequently treated definitively with >1 plate (16% vs 84%; P < .001). Those treated with >1 plate had higher incidence of any complication (14% vs 44%; P < .001). On backwards logistic regression, patients treated with early definitive fixation were 65% less likely to have any complication ( P = .022). Any complication, osteoporosis, and cerebrovascular disease significantly increased risk of unplanned return to the operating room. Conclusion: Early definitive ORIF is safe for select bicondylar tibial plateau fractures.