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. 2016 Dec 1;19(6):342-347.
doi: 10.1016/j.cjtee.2016.08.002.

Complications in the management of closed high-energy proximal tibial plateau fractures

Affiliations

Complications in the management of closed high-energy proximal tibial plateau fractures

Kavin Khatri et al. Chin J Traumatol. .

Abstract

Purpose: To report complications in the management of complex closed proximal tibial fractures.

Method: A retrospective study was conducted to analyze the infectious and noninfectious complications encountered in the management of high-energy Schatzker type V and VI tibial plateau fractures. All patients were treated at the level 1 trauma centre between January 2011 and March 2014. Sixty two patients were included in the study. The mean patient age was (43.16 ± 11.59) years with 60 males and 2 females. Infectious complications like superficial and deep infection, wound dehiscence, malalignment in the immediate postoperative period and in follow-up period were noted.

Results: The overall complication rate was 30.65% (19 out of 62). Infectious complications were noted in 20.97% cases (13/62). In majority of the cases (8/13), superficial infection was seen which managed with regular dressing and antibiotic administration. The patients (5/13) who had developed deep-seated infection were subjected to repeated debridements, flap coverage, implant removal or amputation depending upon the host response. Thirteen patients had experienced noninfectious complications. Hardware related complications were noticed in six patients and four among them received a secondary procedure. Malalignment was observed in seven patients but only single patient underwent subsequent operative intervention.

Conclusion: Proximal tibial plateau fractures especially Shatzker type V and VI are associated with extensive soft tissue damage even in closed injuries. The complications encountered in the management of these fractures can be minimized with appropriate patient selection and minimal soft tissue dissection.

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Figures

Fig. 1
Fig. 1
Wound dehiscence with exposure of lateral tibial locking plate.
Fig. 2
Fig. 2
Flap coverage over the proximal tibia.
Fig. 3
Fig. 3
Multiple discharging sinuses even after repeated debridements.
Fig. 4
Fig. 4
Image showing active discharging sinus from lateral aspect of proximal tibia.
Fig. 5
Fig. 5
Chronic discharging sinus after implant removal.
Fig. 6
Fig. 6
Good range of movement in a patient with chronic discharging sinus.
Fig. 7
Fig. 7
Preoperative CT scan of the patient showing bicondylar fracture of proximal tibia.
Fig. 8
Fig. 8
Progression of varus deformity over one year.
Fig. 9
Fig. 9
Malunited proximal tibia fracture in patient who had undergone plate removal following deep seated infection.

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