Citation

Janes PC, Leonard J, Phillips JL, Bauer BJ, Salottolo K, Slone DS, Mains CW, Bar-Or D. Trauma Surg. Acute Care Open 2017; 2(1): e000119.

Affiliation

Rocky Vista University, Parker, CO, USA.

Copyright

(Copyright © 2017, The author(s) and the American Association for the Surgery of Trauma, Publisher BMJ Publishing Group)

DOI

10.1136/tsaco-2017-000119

PMID

29766110

PMCID

PMC5887585

Abstract

BACKGROUND: Tibial plateau fractures (TPFs) are frequently associated with motor vehicle accidents, auto-pedestrian crashes and falls. However, hospitals near ski resorts commonly treat TPF resulting from skiing. The soft tissue envelope and original mechanism of injury are important determinants in the decision to proceed with immediate or delayed fixation of the fracture. Our objective was to assess whether immediate (≤24 hours) versus delayed (>24 hours) open reduction internal fixation (ORIF) affected in-hospital outcomes among snow sport participants.

METHODS: This was a retrospective study of patients with isolated TPF who were injured while skiing or snowboarding and treated at a Level III Trauma Center that serves four major ski resorts between 2010 and 2013. Clinical characteristics and in-hospital outcomes were obtained from an existing trauma database. Imaging was reviewed to classify the fracture as high (Schatzker IV-VI) or low (Schatzker I-III) energy. Differences in clinical characteristics and outcomes between immediate and delayed ORIF patients were analyzed with χ² and Wilcoxon two-sample tests. These analyses were also performed in the high-energy and low-energy fracture populations.

RESULTS: ORIF was performed on 119 snow sport patients, 93 (78%) immediately. Patients had a median age of 49 years (range 19-70) and were predominantly male (66%). Forty percent sustained a high-energy TPF. No differences were observed between the demographic characteristics, injury severity, Schatzker scores or time from injury to hospital arrival for patients treated immediately versus delayed treatment. Compared with delayed fixation, patients treated immediately had less compartment syndrome (3% vs 27%), needed fewer fasciotomies (6% vs 31%) and had a shorter length of stay (3 vs 6.5 days), p<0.05 for all. These results persisted in the stratified analysis of high-energy fracture patients.

DISCUSSION: Treating patients immediately led to more favorable in-hospital outcomes compared with delayed treatment, even among the patients with a high-energy fracture. LEVEL OF EVIDENCE: Level IV, Therapeutic/Care Management.

Language: en

Keywords

internal fixation; skiing; tibial fracture