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Causes and treatment outcomes of revision surgery after open reduction and internal fixation of tibial plateau fractures

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Abstract

Purpose

Treatment of a tibial plateau fracture (TPF) remains controversial and is generally challenging. Many authors report good results after conventional open reduction and internal fixation in TPF, but complications still occur. This study analyzed causes and outcomes of revision surgery for TPF. The usefulness of a flow chart for revision surgery in TPF was also evaluated.

Methods

We reviewed all patients who underwent more than two operations for a TPF between 2008 and 2015. Finally, 24 cases were selected and retrospectively investigated. The medial tibial plateau angle and proximal posterior tibial angle were radiologically evaluated. The American Knee Society Score (AKSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), range of motion (ROM), and bone union time were investigated after surgery.

Results

Revision surgery for infection was performed in eight cases, for nonunion in six cases, for posttraumatic arthritis (with total knee arthroplasty) in six cases, and for other reasons in four cases. The mean clinical AKSS at final follow-up was 87.3 ± 5.3 (range, 75–95), the functional AKSS was 81.9 ± 5.5 (range, 70–90), the WOMAC score was 9.9 ± 3.1 (range, 5–16), the flexion ROM was 119.8 ± 16.5° (range, 100–150°), and the extension ROM was 2.5 ± 3.3° (range, 0–10°).

Conclusions

Although complications cannot be avoided in some cases, good clinical outcomes are possible when patients are divided according to the presence or absence of infection, with selection of appropriate revision surgery as shown in the flow chart. If an infection is present, treatment should be based on the presence or absence of bone union. If there is no infection, treatment should be based on the presence or absence of nonunion, post-traumatic arthritis, malunion, or immediate post-operative malreduction.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415, South Korea

    Seung Min Ryu, Chang Hyun Choi, Han Seok Yang, Wook Tae Park, Oog Jin Shon & Sam-Guk Park

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  1. Seung Min Ryu
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  2. Chang Hyun Choi
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  3. Han Seok Yang
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Correspondence to Sam-Guk Park.

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Ryu, S.M., Choi, C.H., Yang, H.S. et al. Causes and treatment outcomes of revision surgery after open reduction and internal fixation of tibial plateau fractures. International Orthopaedics (SICOT) 43, 1685–1694 (2019). https://doi.org/10.1007/s00264-018-4080-y

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