Comparison of primary decompressive internal fixation versus delayed surgery for tibial plateau fractures combined with compartment syndrome / 中华创伤骨科杂志

ABSTRACT

Objective To evaluate the clinical outcomes of primary decompressive internal fixation versus delayed surgery for tibial plateau fractures combined with compartment syndrome.Methods From January 2012 to June 2014,a total of 39 patients were treated at our department for tibial plateau fracture combined with compartment syndrome.Early operation was adopted for 18 patients in whom decompression by incisions via the medial and lateral approaches combined with internal fixation with plate and screws was performed at the primary stage and dermoplasty or wound closure conducted at the secondary stage after conditions of soft tissue allowed.Delayed operation was adopted for 21 patients in whom external fixation and decompression by incisions via the medial and lateral approaches was performed in the emergency management followed by selective open reduction and internal fixation.The 2 groups were compared in terms of indexes associated with surgery and hospitalization,Lysholm scores,EuroQol 5 dimensions (EQ-5D) indexes and visual analogue scale (VAS) at final follow-ups.Results All the patients were followed up for more than 2 years.The early operation group incurred significantly less operation time (229.1 ± 43.7 min),intraoperative blood loss (297.5 ±51.5 mL),hospital stay (11.9 ± 1.9 d) and expenditure [144,700 (103,200,179,900) Yuan RMB] than the delayed operation group [322.1 ±62.2 min,385.9 ±56.4 mL,21.5 ±3.6 d,and 197,700 (137,200,234,300) Yuan RMB,respectively] (P ＜ 0.05).There were no significant differences between the 2 groups in rate of complications [22.2％ (4/18) versus 38.1％ (8/21)],fracture union time (6.1±1.1 mversus5.8±l.4m),Lysholmscores (83.9±9.7 versus 81.1±12.3),EQ-5Dindexes (0.85±0.09versus0.84±0.12),orVAS (1.3±1.2versus 1.5±1.4) (P＞ 0.05).Conclusions In the treatment of tibial plateau fractures combined with compartment syndrome,both primary decompressive internal fixation and delayed surgery can achieve satisfactory clinical outcomes.The former is more appropriate for those without obvious limb ischemia while the latter more appropriate for those whose priority is limb salvage due to serious osteofascial compartment syndrome.Surgeons should choose reasonable procedures according to the specific conditions of the patients and strict surgical indications.