RANDOMIZED TRIAL OF BICONDYLAR TIBIAL PLATEAU FRACTURES TREATED WITH AO OR RING FIXATOR METHODS: EARLY REINTERVENTION RATES FOR COMPLICATIONS.

Abstract

In five teaching hospitals, seventy-two patients with seventy-three bicondylar tibial plateau fractures were prospectively randomized by envelope to treatment either by AO methods (group A) or ring fixator methods (group B). Outcome measures included clinical and radiographic parameters, & HSS knee scores.

Results: Re-intervention was necessary within six months in ten group A & seven Group B patients. Forty-three procedures were performed (thirty-three Group A-ten Group B) I& D 12- 3: STSG 3-0: Quadricepsplasty 1-0; Manipulation 2–4; Muscle flap 2–0; Above knee amputation 1–0; Revision ORIF 5–1; Revision Rings 0–1; Bone graft 2–1; Bead pouch 3-0; Synovectomy 1-0; Sequestrectomy 1-0.

More patients had more septic and wound complications resulting in more need for re-intervention following ORIF.

Conclusion. For bi-condylar tibial plateau fractures (OTA 41.C) six-month HSS scores are significantly higher after treatment with Ring Fixator methods. Reintervention rates for deep sepsis/wound problems are higher with AO methods. Wound and infection complications occurring after AO treatment are more severe and require multiple procedures for control.

We have conducted a prospective randomized trial to determine the outcomes of treatment by

1. Open reduction and internal fixation or

2. Closed reduction and ring fixation for the treatment of bi-condylar tibial plateau fractures (OTA 41.C)

We report our early findings on re-intervention rates for complications.

In five teaching hospitals, seventy-two patients with seventy-three bi-condylar tibial plateau fractures were prospectively randomized by envelope to treatment either by AO methods (group A) or ring fixator methods (group B). Outcome measures included clinical and radiographic parameters, & HSS knee scores. Randomization gave the following demographics

Re-intervention was necessary within six months in ten group A & seven Group B patients. Forty-three procedures were performed (thirty-three Group A-ten Group B) I& D 12- 3: STSG 3-0: Quadricepsplasty 1-0; Manipulation 2-4; Muscle flap 2-0; Above knee amputation 1-0; Revision ORIF 5-1; Revision Rings 0-1; Bone graft 2-1; Bead pouch 3-0; Synovectomy 1-0; Sequestrectomy 1-0.

More patients had more septic and wound complications resulting in more need for re-intervention following ORIF.

For bi-condylar tibial plateau fractures (OTA 41.C) six-month HSS scores are significantly higher after treatment with Ring Fixator methods. Reintervention rates for deep sepsis/wound problems are higher with AO methods. Wound and infection complications occurring after AO treatment are more severe and require multiple procedures for control.

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