An Acute Fixation Protocol for High-Energy Tibial Plateau Fractures Decreases Time to Fixation and Lowers Operative Costs Without Affecting Wound Complications and Reoperations
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved..
OBJECTIVES: To investigate whether an acute fixation protocol for high-energy tibial plateau fractures increases the rate of wound complications.
DESIGN: Retrospective comparative study.
SETTING: Urban level 1 trauma center.
PATIENTS/PARTICIPANTS: One hundred thirty-four patients with high-energy tibial plateau fractures (OTA/AO 41B/C [Schatzker VI/V/VI]) treated with open reduction and internal fixation (ORIF).
INTERVENTION: Utilization of an acute ORIF (<48 hours) versus delayed ORIF protocol.
MAIN OUTCOME MEASURE: Primary outcomes: wound complications (wound dehiscence/necrosis, superficial/deep infections) and reoperations. Secondary outcomes: total operative costs and hospital length of stay.
RESULTS: Overall, 83.9% (26/31) of patients received definitive fixation within 48 hours under the acute ORIF protocol versus 18.4% (19/103) of patients treated under the standard delayed protocol with no observed differences in the rate of wound complications (proportional difference (PD) -4.6%, confidence interval (CI) -17.2% to 11.3%; P = 0.78) or reoperations (PD 2.0%, CI, 13.0% to 12.5%; P = 1.00). The acute ORIF protocol lowered operative costs (median difference (MD) $-2.563.00, CI, 3021.00 to -1661.00; P < 0.001) and hospital length of stay (MD 4.0 days, CI, 6.0-1.0; P = 0.001). On multivariate analysis, wound complications were associated with increasing age (odds ratio (OR) 1.05, CI, 1.01-1.10; P = 0.01) and tobacco use (OR 3.75, CI, 1.19-11.82; P = 0.02).
CONCLUSION: An acute ORIF protocol for high-energy tibial plateau fractures decreased time to fixation and lowered operative costs without increasing the risk of wound complications or reoperations.
LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:37 |
|---|---|
| Enthalten in: |
Journal of orthopaedic trauma - 37(2023), 6 vom: 01. Juni, Seite 287-293 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Kim, Ye Joon [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
|---|
| Anmerkungen: |
Date Completed 19.05.2023 Date Revised 22.05.2023 published: Print Citation Status MEDLINE |
|---|
| doi: |
10.1097/BOT.0000000000002571 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM35238526X |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM35238526X | ||
| 003 | DE-627 | ||
| 005 | 20231226053613.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1097/BOT.0000000000002571 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1174.xml |
| 035 | |a (DE-627)NLM35238526X | ||
| 035 | |a (NLM)36728248 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Kim, Ye Joon |e verfasserin |4 aut | |
| 245 | 1 | 3 | |a An Acute Fixation Protocol for High-Energy Tibial Plateau Fractures Decreases Time to Fixation and Lowers Operative Costs Without Affecting Wound Complications and Reoperations |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 19.05.2023 | ||
| 500 | |a Date Revised 22.05.2023 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved. | ||
| 520 | |a OBJECTIVES: To investigate whether an acute fixation protocol for high-energy tibial plateau fractures increases the rate of wound complications | ||
| 520 | |a DESIGN: Retrospective comparative study | ||
| 520 | |a SETTING: Urban level 1 trauma center | ||
| 520 | |a PATIENTS/PARTICIPANTS: One hundred thirty-four patients with high-energy tibial plateau fractures (OTA/AO 41B/C [Schatzker VI/V/VI]) treated with open reduction and internal fixation (ORIF) | ||
| 520 | |a INTERVENTION: Utilization of an acute ORIF (<48 hours) versus delayed ORIF protocol | ||
| 520 | |a MAIN OUTCOME MEASURE: Primary outcomes: wound complications (wound dehiscence/necrosis, superficial/deep infections) and reoperations. Secondary outcomes: total operative costs and hospital length of stay | ||
| 520 | |a RESULTS: Overall, 83.9% (26/31) of patients received definitive fixation within 48 hours under the acute ORIF protocol versus 18.4% (19/103) of patients treated under the standard delayed protocol with no observed differences in the rate of wound complications (proportional difference (PD) -4.6%, confidence interval (CI) -17.2% to 11.3%; P = 0.78) or reoperations (PD 2.0%, CI, 13.0% to 12.5%; P = 1.00). The acute ORIF protocol lowered operative costs (median difference (MD) $-2.563.00, CI, 3021.00 to -1661.00; P < 0.001) and hospital length of stay (MD 4.0 days, CI, 6.0-1.0; P = 0.001). On multivariate analysis, wound complications were associated with increasing age (odds ratio (OR) 1.05, CI, 1.01-1.10; P = 0.01) and tobacco use (OR 3.75, CI, 1.19-11.82; P = 0.02) | ||
| 520 | |a CONCLUSION: An acute ORIF protocol for high-energy tibial plateau fractures decreased time to fixation and lowered operative costs without increasing the risk of wound complications or reoperations | ||
| 520 | |a LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Scott, Tyler |e verfasserin |4 aut | |
| 700 | 1 | |a Richard, Raveesh D |e verfasserin |4 aut | |
| 700 | 1 | |a Parry, Joshua A |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Journal of orthopaedic trauma |d 1996 |g 37(2023), 6 vom: 01. Juni, Seite 287-293 |w (DE-627)NLM012994979 |x 1531-2291 |7 nnns |
| 773 | 1 | 8 | |g volume:37 |g year:2023 |g number:6 |g day:01 |g month:06 |g pages:287-293 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1097/BOT.0000000000002571 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 37 |j 2023 |e 6 |b 01 |c 06 |h 287-293 | ||