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. 2024 Aug;34(6):3275-3280.
doi: 10.1007/s00590-024-04067-6. Epub 2024 Aug 13.

Outpatient surgery for tibial plateau fractures

Adam M Schlauch  1 , Benjamin Crawford  2 , Ishan Shah  2 , Amit Piple  2 , Alejandro Cortes  2 , Stephanie Chang  2 , Anton Denisov  3   4 , Daemeon Nicolaou  5 , Bo He  5
Affiliations

Outpatient surgery for tibial plateau fractures

Adam M Schlauch et al. Eur J Orthop Surg Traumatol. 2024 Aug.

Abstract

Purpose: The purpose of this study was to determine the rates of compartment syndrome and other early complications following outpatient open reduction and internal fixation (ORIF) of tibial plateau fractures.

Methods: This was a retrospective cohort at a single US level I academic trauma centre of patients with tibial plateau fractures managed operatively. Inpatients received their definitive ORIF during their index hospital stay and were admitted post-operatively following ORIF. Outpatients were scheduled for ambulatory surgery during definitive ORIF. Exclusion criteria for outpatient surgery included compartment syndrome, polytrauma, open types IIIb/IIIc, and patients who received any internal fixation during index presentation. The primary outcome measure was post-operative compartment syndrome. Secondary outcomes were return to the 90-day return to the ED, 90-day readmission, surgical wound infection, thromboembolism, and 90-day mortality. An intention-to-treat (ITT) and as-treated (AT) analyses were performed.

Results: Totally, 71 inpatients and 47 outpatients were included. There were no cases of post-operative compartment syndrome. In the ITT analysis, there were no differences for inpatients vs outpatients for 90-day re-admission (22.5% vs 12.8%, p = 0.275), 90-day return to the ED (35.2% vs 17.0%, p = 0.052), infection (12.7% vs 2.1%, p = 0.094), DVT (7% vs 4.3%, p = 0.819), or PE 1.4% vs 0.0%, p = 1.000). The AT analysis showed a significantly higher 90-day re-admission (26.9% vs 2.5%, p = 0.003) and 90-day ED visit (38.5% vs 7.5%, p = 0.001) rate in the inpatient group.

Conclusions: Appropriately selected patients with isolated tibial plateau fractures can have non-inferior rates of compartment syndrome and post-operative complications when compared to inpatients.

Keywords: Compartment syndrome; Complications; Outpatient; Plateau; Readmission.

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