Complications of High-Energy Bicondylar Tibial Plateau Fractures Treated With Dual Plating Through 2 Incisions

Objectives: To characterize the rate of complications after operative fixation of bicondylar (OTA/AO 41-C) tibial plateau fractures and to evaluate the contribution of common risk factors. Design: Retrospective review. Setting: Level 1 regional trauma center. Patients/Participants: One hundred thirty-eight patients older than 18 years with 140 bicondylar tibial plateau fractures were participated in this study. Intervention: Open reduction and internal fixation using medial and lateral plate construct through 2 incisions. Main Outcome Measurements: Development of a deep infection or a nonunion. Results: The overall major complication rate was 27.9%: 23.6% deep infection and 10.0% nonunion. Open fractures were associated with a higher rate of infection: 43.8% versus 21.0% for closed injuries (odds ratio = 2.96, P = 0.05). Fasciotomy closure before definitive fixation was associated with significantly fewer deep infections compared with internal fixation with open fasciotomy wounds: 11.8% versus 50.0% (odds ratio = 7.5, P = 0.05). The presence of compartment syndrome, tobacco use, diabetes, and timing of surgery had no statistically significant association on the rate of infection or nonunion. Conclusions: Nonunion and deep infections occur commonly after staged open reduction and internal fixation of high-energy tibial plateau fractures. Open fractures and open fasciotomy wounds at the time of internal fixation are associated with higher rates of infection.