Proximal Tibial Metaphyseal Fractures with Severe Soft Tissue Injury: Clinical and Functional Results at 2 Years

Department of Orthopaedic Surgery, Carolinas Medical Center, 1616 Scott Avenue, Charlotte, NC, 28203, USA, .
Clinical Orthopaedics and Related Research (Impact Factor: 2.77). 10/2009; 468(6):1669-75. DOI: 10.1007/s11999-009-1148-4
Source: PubMed


Controversy exists regarding management of proximal tibial metaphyseal fractures with severe soft tissue injury. It is unclear whether limb salvage or early amputation results in the best functional and clinical outcomes.
We hypothesized that in this group of patients, there is no difference in functional outcomes, complication rates, clinical outcomes, or objective physical function related to the treatment approach.
We used the LEAP study database to perform a retrospective comparative review of a subset of patients with proximal tibial metaphyseal fractures (AO/OTA 41A, B, and C) with associated severe soft tissue injuries comparing the outcomes of patients who were treated with either limb salvage or amputation.
Although there were major differences in clinical and functional outcomes based on patients' sociodemographics at 2 years, no differences in clinical or functional outcomes were detected regardless of whether amputation or limb salvage was performed. Severity of soft tissue injury was more predictive of outcome than the surgical approach used.
Sociodemographics and soft tissue injury severity are more important than treatment approach for predicting clinical and functional outcomes at 2 years in patients with proximal tibia metaphyseal fractures with severe soft tissue injury.
Level III, retrospective comparative study. See Guidelines for Authors for a complete description of levels of evidence.

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Available from: Renan Castillo, Dec 04, 2014
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    • "Fractures of the proximal tibia are serious injuries and present a treatment challenge. Because they result from high energy injuries, damage is usually extensive and open fractures, compartment syndromes, and vessel injuries are commonly associated.1,2) Traditional open plating presents complications, such as, infection and delayed soft tissue breakdown, despite developments over past decades. "
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    ABSTRACT: Relatively few studies have addressed plate osteosynthesis for open proximal tibial fractures by now. The purpose of this study was to assess the results of minimally invasive plate osteosynthesis (MIPO) for open fractures of the proximal tibia. Thirty-four patients with an open proximal tibial fracture were treated by MIPO. Thirty of these, who followed for over 1 year, constituted the subject of this retrospective study. According to the AO Foundation and Orthopaedic Trauma Association (AO-OTA) classification, there were 3 patients of type 41-C, 6 of type 42-A, 8 of type 42-B, and 13 of type 42-C. In terms of the Gustilo and Anderson's open fracture grading system, 11 patients were of grade I, 6 were of grade II, and 13 were of grade III (III-A, 6; III-B, 6; III-C, 1). After thorough debridement and wound cleansing, when necessary, a soft tissue flap was placed. Primary MIPO (simultaneous plate fixation with soft tissue procedures) was performed in 18 patients, and staged MIPO (temporary external fixation followed by soft tissue procedures and subsequent conversion to plate fixation after soft tissue healing) was performed in 12 patients. Results were assessed according to the achievement and time to union, complications (including infections), and function of the knee joint using Knee Society scores. Statistical analysis was performed to identify factors influencing results. Primary union was achieved by 24 of the 30 study subjects. Early bone grafting was performed in 6 cases with a massive initial bone defect expected to result in non-union. No patient had malalignment greater than 10°. The mean Knee Society score was 88.7 at final follow-up visits, 23 patients achieved an excellent result, and 7 a good result. There were 3 superficial and 5 deep infections, but none required early implant removal. Functional results were similar for primary and staged MIPO (p = 0.113). Fracture pattern (p = 0.089) and open fracture grade (p = 0.079) were not found to influence the results. If soft tissue coverage is adequately performed, MIPO could be regarded as an acceptable method for the treatment of open proximal tibial fracture.
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    ABSTRACT: Objective To share our preliminary clinical success and failure with using an external locking compression plate (LCP) for proximal tibial fractures, further refine the indications for this procedure and review relevant published reports.Methods The current study reports two cases of proximal tibial fracture treated with external LCP as the second stage of a two-stage treatment. One patient was a 59-year-old man with a closed proximal tibial/fibular fracture caused by falling on ice while getting out of his car, and another patient was a 42-year-old male smoker with right comminuted proximal tibia, tibial plateau and proximal fibular fractures. The outcomes were evaluated by radiographs and weight bearing status.ResultsIn the first case, the fracture healed uneventfully whereas the second case required further open-reduction with internal fixation because correct alignment could not be achieved with an external LCP.Conclusion Correct alignment of proximal tibial fractures followed by use of an external LCP can achieve favorable outcomes.
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