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Original Article
Skiers and snowboarders have improved short-term outcomes with immediate fixation of tibial plateau fractures
  1. Peter C Janes1,2,
  2. Jan Leonard3,4,5,6,
  3. Jennifer L Phillips1,2,
  4. Brent J Bauer7,
  5. Kristin Salottolo3,4,5,6,
  6. Denetta S Slone8,9,
  7. Charles W Mains6,10,
  8. David Bar-Or3,4,5,6,9
  1. 1Department of Surgery, St. Anthony Summit Medical Center, Frisco, CO, USA
  2. 2Vail-Summit Orthopaedics & Sports Medicine, Frisco, CO, USA
  3. 3Department of Trauma Research, Medical City Plano, Plano, TX, USA
  4. 4Department of Trauma Research, Swedish Medical Center, Englewood, CO, USA
  5. 5Department of Trauma Research, St. Anthony Hospital, Lakewood, CO, USA
  6. 6Department of Trauma Research, Penrose Hospital, Colorado Springs, CO, USA
  7. 7Department of Orthopaedic Surgery, Medical City Plano, Plano, TX, USA
  8. 8Department of Trauma Services, Swedish Medical Center, Englewood, CO, USA
  9. 9Rocky Vista University, Parker, CO, USA
  10. 10Department of Trauma Services, St. Anthony Hospital, Lakewood, CO, USA
  1. Correspondence to Dr David Bar-Or, Swedish Medical Center, Englewood, CO 80113, USA; dbaror{at}ampiopharma.com

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.

  • tibial fracture
  • internal fixation
  • skiing

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/tsaco-2017-000119

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    Footnotes

    • Presented at the 2017 American Association for the Surgery of Trauma Annual Meeting; 2017 International Conference of the Society for Skiing Safety.

    • Contributors PCJ conceived of the study, participated in its design and data collection, interpreted data and provided critical revisions. JL participated in the study design and literature search, performed the statistical analysis and drafted the manuscript. JLP participated in the literature search, data collection and data interpretation and provided critical manuscript revisions. KS participated in the study design and provided analysis guidance and critical manuscript revision. BJB, DSS and CWM provided critical manuscript revisions. DBO participated in the study design and provided critical manuscript revisions. All authors read and approved the final manuscript.

    • Competing interests None declared.

    • Ethics approval Catholic Health Initiatives Institute for Research and Innovation Institutional Review Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.