Journal of orthopaedic trauma · 2026
Outcomes of Nonunion Surgery After Tibial Plateau Fractures: A Case Series of 28 Patients.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Gregg Austin T, Lehle Carla H, Wagner Robert K, Fan Sikun, Musick Adam N, Muhammad Maaz, Policicchio Thomas J, Doornberg Job N, Stenquist Derek, Ly Thuan V, von Keudell Arvind G, Aneja Arun
Аннотация
OBJECTIVES: To evaluate outcomes of tibial plateau fracture nonunion surgery, including rates of final radiographic healing, additional surgery, and conversion to total knee arthroplasty (TKA).
DESIGN: Retrospective case series.
SETTING: Two Level I academic trauma centers.
PATIENTS: Adult patients who underwent nonunion surgery after open reduction internal fixation of tibial plateau fractures (OTA/AO 41B-C) between 2000 and 2024 were included.
OUTCOME MEASURES AND COMPARISONS: The primary outcome was final radiographic healing. Secondary outcomes included additional surgery and conversion to TKA.
RESULTS: Twenty-eight patients were included (median age 55 years (IQR: 38-61), 57% male). The median follow-up from the date of the nonunion surgery was 19 months (IQR:13-33). Twenty-one (75%) fractures were classified as Schatzker VI. Nonunion surgery involved revision open reduction internal fixation in 23 (82%) cases, bone grafting alone (with or without hardware removal) in 3 (11%) cases, screw augmentation in 1 (3.6%) patient, and 1 patient (3.6%) underwent multistage treatment, ending with definitive treatment using an Ilizarov frame for 6 months. Overall, 54% of patients received bone grafting to address bone defects. Radiographic healing was achieved in 24 patients (86%). All 4 (14%) patients with a persistent nonunion had Schatzker VI fractures. Of these, 3 (75%) ultimately underwent conversion to TKA, whereas 1 had no further surgery until the last follow-up 12.4 months after the initial procedure. Overall, 13 (46%) patients required additional surgery, of which 5 (18%) underwent TKA at a median of 3.1 years (IQR: 1.68-6.74).
CONCLUSION: In the current study of patients who underwent tibial plateau fracture nonunion surgery, 86% of patients ultimately achieved radiographic healing, with 71% healed after the index nonunion surgery. Close to half of the patients required additional surgery, with 14% who underwent further procedures to achieve healing, and 18% ultimately required conversion to TKA. These findings can help surgeons counsel patients and guide expectations after surgery for tibial plateau fracture nonunion.
LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
DESIGN: Retrospective case series.
SETTING: Two Level I academic trauma centers.
PATIENTS: Adult patients who underwent nonunion surgery after open reduction internal fixation of tibial plateau fractures (OTA/AO 41B-C) between 2000 and 2024 were included.
OUTCOME MEASURES AND COMPARISONS: The primary outcome was final radiographic healing. Secondary outcomes included additional surgery and conversion to TKA.
RESULTS: Twenty-eight patients were included (median age 55 years (IQR: 38-61), 57% male). The median follow-up from the date of the nonunion surgery was 19 months (IQR:13-33). Twenty-one (75%) fractures were classified as Schatzker VI. Nonunion surgery involved revision open reduction internal fixation in 23 (82%) cases, bone grafting alone (with or without hardware removal) in 3 (11%) cases, screw augmentation in 1 (3.6%) patient, and 1 patient (3.6%) underwent multistage treatment, ending with definitive treatment using an Ilizarov frame for 6 months. Overall, 54% of patients received bone grafting to address bone defects. Radiographic healing was achieved in 24 patients (86%). All 4 (14%) patients with a persistent nonunion had Schatzker VI fractures. Of these, 3 (75%) ultimately underwent conversion to TKA, whereas 1 had no further surgery until the last follow-up 12.4 months after the initial procedure. Overall, 13 (46%) patients required additional surgery, of which 5 (18%) underwent TKA at a median of 3.1 years (IQR: 1.68-6.74).
CONCLUSION: In the current study of patients who underwent tibial plateau fracture nonunion surgery, 86% of patients ultimately achieved radiographic healing, with 71% healed after the index nonunion surgery. Close to half of the patients required additional surgery, with 14% who underwent further procedures to achieve healing, and 18% ultimately required conversion to TKA. These findings can help surgeons counsel patients and guide expectations after surgery for tibial plateau fracture nonunion.
LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.