Complications Associated With Internal Fixation of High-Energy Bicondylar Tibial Plateau Fractures Utilizing a Two-Incision Technique

Barei, David P.; Nork, Sean E.; Mills, W. J.; Henley, M. Bradford; Benirschke, Stephen K.

doi:10.1097/00005131-200411000-00001

Cited by 399 publications

(313 citation statements)

References 29 publications

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“…Harborview reported 14.5% compartment syndrome in a similar population [2]. Our study showed a 10% rate of compartment syndrome treated with fasciotomies, very much in line with the existing literature, and the timing of the application of the external fixator did not correlate with the diagnosis of compartment syndrome.…”

Section: Discussionsupporting

confidence: 89%

“…Multiple studies have demonstrated reduced infection rates with this protocol [2,[4][5][6]12]. However, the question of the urgency with which the temporizing external fixation must be applied has not been addressed.…”

Section: Discussionmentioning

confidence: 99%

“…With historical rates of infection after early definitive fixation for these injuries approaching 50% in some series, a staged protocol with early external fixation followed by delayed definitive internal fixation has been widely adopted [7,13,16]. Despite this treatment algorithm, wound complications persist, and deep infection rates are reported to be between 5% and 24% [2,[4][5][6]12]. Given this high complication rate and the increased focus on resource utilization, identifying the ideal timing of surgical intervention for spanning external fixation is clinically significant.…”

Section: Introductionmentioning

confidence: 99%

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Does Early versus Delayed Spanning External Fixation Impact Complication Rates for High-energy Tibial Plateau and Plafond Fractures?

Haller

Holt

Rothberg

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background High-energy tibial plateau and tibial plafond fractures have a high complication rate and are frequently treated with a staged approach of spanning external fixation followed by definitive internal fixation after resolution of soft tissue swelling. A theoretical advantage to early spanning external fixation is that earlier fracture stabilization could prevent further soft tissue damage and potentially reduce the occurrence of subsequent infection. However, the relative urgency of applying the external fixator after injury is unknown, and whether delay in this intervention is correlated to subsequent treatment complications has not been examined. Questions/purposes Is delay of more than 12 hours to spanning external fixation of high-energy tibial plateau and plafond fractures associated with increased (1) infection risk; (2) compartment syndrome risk; and (3) time to definitive fixation, length of hospitalization, or risk of secondary surgeries? We further stratified our results based on injury site: plateau and plafond. In practical clinical terms, many of these high-energy C-type articular fractures will arrive at the regional trauma center in the evening and this investigation attempted to explore if these injuries need to be placed in temporizing fixators that evening or if they may be safely addressed in a dedicated trauma room the next morning. Methods We performed a retrospective review of all patients at a Level I university trauma center with highenergy tibial plateau and plafond fractures who underwent staged treatment with a spanning external fixation followed by subsequent definitive internal fixation between 2006 and 2012. Patients who received a fixator within 12 hours of recorded injury time were classified as early external fixation; those who received a fixator greater than 12 hours from injury were classified as delayed external fixation. There were 80 patients (42 plateaus and 38 plafonds) in the early external fixation cohort and 79 patients (45 plateaus and 34 plafonds) in the delayed external fixation cohort. Deep infection rate was 13% in plateau fractures and 18% in plafond fractures. Rates of infection, compartment One of the authors (ENK) has received research support funding from the Department of Defense Congressionally Directed Medical Research Program and VA Early Feasibility Program. One of the authors (TFH) lists the following relevant financial activities outside of this work and/or any other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, this manuscript: DePuy Synthes (West Chester, PA, USA) in the amount of less than USD 10,000. One of the authors (ENK) lists the following relevant financial activities outside of this work and/or any other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, this manuscript: CoNextions (Sandy, UT, USA) in the amount of more than USD 10,000, OrthoGrid (Salt Lake City...

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Does Early versus Delayed Spanning External Fixation Impact Complication Rates for High-energy Tibial Plateau and Plafond Fractures?

Haller

Holt

Rothberg

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Bacterial cultures were grown in Cation Adjusted Mueller Hinton Broth to an optical density (OD) 600 1.259 g of D-Met, and 1.259 g of D-Phe in 100 mL culture medium (aMEM; Sigma) supplemented with 10% fetal bovine serum, 100 IU/mL penicillin, and 100 lg/mL streptomycin) at 37 o C and adjusting to pH 7.5 to 8 using 0.5 N HCl. D-AA stock solution was diluted with culture medium to achieve the targeted concentration, and culture medium and D-AAs were refreshed every other day.…”

Section: Biofilm Inhibition and Dispersal Assaysmentioning

confidence: 99%

“…Although clinical studies have underscored the relationship between infection and nonunion of diaphyseal fractures [24], periarticular fractures also have high rates of infections complications. The deep infection rate of patients with Schatzker Type VI bicondylar tibial plateau fractures treated by a two-incision dual-plating technique ranged from 11% to 23% [1,43] and approached 30% if treated more than 72 hours after injury [19]. Thus, inhibiting the formation of a biofilm may be an alternative strategy for reducing the incidence of infectious complications and nonunions.…”

Section: Introductionmentioning

confidence: 99%

d-amino Acid Inhibits Biofilm but not New Bone Formation in an Ovine Model

Harmata

Sánchez

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Infectious complications of musculoskeletal trauma are an important factor contributing to patient morbidity. Biofilm-dispersive bone grafts augmented with D-amino acids (D-AAs) prevent biofilm formation in vitro and in vivo, but the effects of D-AAs on osteocompatibility and new bone formation have not been investigated.Questions/purposes We asked: (1) Do D-AAs hinder osteoblast and osteoclast differentiation in vitro? (2) Does local delivery of D-AAs from low-viscosity bone grafts inhibit new bone formation in a large-animal model? Methods Methicillin-sensitive Staphylococcus aureus and methicillin-resistant S aureus clinical isolates, mouse bone marrow stromal cells, and osteoclast precursor cells were treated with an equal mass (1:1:1) mixture of D-Pro:DMet:D-Phe. The effects of the D-AA dose on biofilm inhibition (n = 4), biofilm dispersion (n = 4), and bone marrow stromal cell proliferation (n = 3) were quantitatively measured by crystal violet staining. Osteoblast differentiation was quantitatively assessed by alkaline phosphatase staining, von Kossa staining, and quantitative reverse transcription for the osteogenic factors a1Col1 and Ocn (n = 3). Osteoclast differentiation was quantitatively measured by tartrate-resistant acid phosphatase staining (n = 3). Bone grafts augmented with 0 or 200 mmol/L D-AAs were injected in ovine femoral condyle defects in four sheep. New bone formation was evaluated by lCT and histology 4 months later. An a priori power analysis indicated that a sample size of four would detect a 7.5% difference of bone volume/total volume between groups assuming a mean and SD of 30% and 5%, respectively, with a power of 80% and an alpha level of 0.05 using a two-tailed t-test between the means of two independent samples. Results Bone marrow stromal cell proliferation, osteoblast differentiation, and osteoclast differentiation were inhibited at D-AAs concentrations of 27 mmol/L or greater in a dose-responsive manner in vitro (p \ 0.05). InThe institution of one or more of the authors (SAG, FE, JCW) has received, during the study period, funding from the Orthopaedic Extremity Trauma Research Program (SAG and JCW), the National Institute of Arthritis and Musculoskeletal Diseases (SAG, JCW, and FE), Medtronic, Inc (SAG); Oak Ridge Institute (AJH); and the National Institutes of Health (SAG). One of the authors certifies that he (SAG), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount less than USD 10,000, from Medtronic Spine and Biologics (Memphis, TN, USA).

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Prevalence of Deep Surgical Site Infection After Repair of Periarticular Knee Fractures

et al. 2019

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Complications Associated With Internal Fixation of High-Energy Bicondylar Tibial Plateau Fractures Utilizing a Two-Incision Technique

Cited by 399 publications

References 29 publications

Does Early versus Delayed Spanning External Fixation Impact Complication Rates for High-energy Tibial Plateau and Plafond Fractures?

Does Early versus Delayed Spanning External Fixation Impact Complication Rates for High-energy Tibial Plateau and Plafond Fractures?

d-amino Acid Inhibits Biofilm but not New Bone Formation in an Ovine Model

Prevalence of Deep Surgical Site Infection After Repair of Periarticular Knee Fractures

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