Failure of fixation of tibial plateau fractures

Objective: To define the failure of fixation in tibial plateau fractures, detect its incidence, and determine the contributing factors. Design: Mail survey and literature review were used to define the fixation failure; this definition was applied to a radiologic review of patients who were treated surgically for tibial plateau fracture at a Level I trauma unit for a three-year period from 1993 to 1995. Patients and Setting: Forty-two consecutive patients treated surgically at our trauma unit for tibial plateau fractures were studied retrospectively, specifically for loss of fixation. Factors that might affect the fracture fixation were reviewed, including age, mechanism of injury, type of fracture, bone quality, severity of fragmentation, severity of displacement, time to surgery, operating time, fixation method, use of bone graft, postoperative bracing, and mobilization. Main Outcome Measures: The main outcome measure was failure of fixation, by using criteria defined by the result of a mail survey of experts and literature review. Results: Using a strict definition of radiologic failure of fixation, we reported an overall 31 percent rate of failure of fixation: 79 percent in patients older than sixty years compared with 7 percent in younger patients. The statistically significant associations with loss of reduction were age more than sixty years, premature weight bearing, preoperative displacement, fracture fragmentation, and severe osteoporosis. Conclusion: It is logical to define failure of fixation using the same measures considered as indications for reduction and fixation. Using these strict criteria, the incidence of radiologic failure was much higher than previous published series. In the elderly this was unacceptably high, and treatment goals should be limited to restoring stability and alignment.