TY - JOUR
T1 - Lack of standardisation in the management of complex tibial plateau fractures
T2 - a multicentre experience
AU - Hörmandinger, Christina
AU - Bitschi, David
AU - Berthold, Daniel P
AU - Neidlein, Claas
AU - Schroeder, Lennart
AU - Watrinet, Julius
AU - Pätzold, Robert
AU - Böcker, Wolfgang
AU - Holzapfel, Boris Michael
AU - Fürmetz, Julian
AU - Bormann, Markus
N1 - Lehr-KH Trauma Center Murnau, Murnau am Staffelsee, Germany
PY - 2024/12
Y1 - 2024/12
N2 - OBJECTIVE: In recent years, the trauma mechanisms and fracture types in tibial plateau fractures (TPF) have changed. At the same time, treatment strategies have expanded with the establishment of new classification systems, extension of diagnostics and surgical strategies. Evidence-based recommendations for treatment strategies are rare. The aim of this study is to assess the extent of standardization in the treatment of complex TPF.MATERIAL AND METHODS: For the study, specialists in trauma surgery/orthopaedics were presented thin-slice CT data sets of three complex TPFs including 3D reconstructions. A standardized questionnaire on fracture morphology and planned treatment strategy was then completed.RESULTS: A total of 23 surgeons from 7 hospitals (Trauma center levels I-III) were included. All three fractures were most frequently classified as Schatzker type V (fracture I: 52.2%, II: 56.5%, III: 60%). Averaged over all three fractures, 55% of the respondents chose the same patient positioning. The combination of a posteromedial and anterolateral approach was the most frequently chosen approach at 42.7%. Double plating was favored for the surgical treatment of all fractures (70.7%). Preoperative MRI, extended approaches and intraoperative fraturoscopy were significantly more common in level I trauma centres.CONCLUSION: There are major differences in the management of complex TPF. 360° treatment is carried out in all departments regardless of the level of care, but without further standardization in terms of preoperative imaging, classification, initial treatment, approach, fixation and intraoperative imaging. There are major differences within the departments with different level of care.
AB - OBJECTIVE: In recent years, the trauma mechanisms and fracture types in tibial plateau fractures (TPF) have changed. At the same time, treatment strategies have expanded with the establishment of new classification systems, extension of diagnostics and surgical strategies. Evidence-based recommendations for treatment strategies are rare. The aim of this study is to assess the extent of standardization in the treatment of complex TPF.MATERIAL AND METHODS: For the study, specialists in trauma surgery/orthopaedics were presented thin-slice CT data sets of three complex TPFs including 3D reconstructions. A standardized questionnaire on fracture morphology and planned treatment strategy was then completed.RESULTS: A total of 23 surgeons from 7 hospitals (Trauma center levels I-III) were included. All three fractures were most frequently classified as Schatzker type V (fracture I: 52.2%, II: 56.5%, III: 60%). Averaged over all three fractures, 55% of the respondents chose the same patient positioning. The combination of a posteromedial and anterolateral approach was the most frequently chosen approach at 42.7%. Double plating was favored for the surgical treatment of all fractures (70.7%). Preoperative MRI, extended approaches and intraoperative fraturoscopy were significantly more common in level I trauma centres.CONCLUSION: There are major differences in the management of complex TPF. 360° treatment is carried out in all departments regardless of the level of care, but without further standardization in terms of preoperative imaging, classification, initial treatment, approach, fixation and intraoperative imaging. There are major differences within the departments with different level of care.
KW - Humans
KW - Tibial Fractures/surgery
KW - Fracture Fixation, Internal/methods
KW - Tomography, X-Ray Computed
KW - Male
KW - Female
KW - Imaging, Three-Dimensional
KW - Trauma Centers
KW - Surveys and Questionnaires
KW - Adult
KW - Middle Aged
KW - Practice Patterns, Physicians'/statistics & numerical data
KW - Bone Plates
KW - Patient Positioning
KW - Tibial Plateau Fractures
U2 - 10.1007/s00068-024-02616-6
DO - 10.1007/s00068-024-02616-6
M3 - Original Article
C2 - 39095621
SN - 1863-9933
VL - 50
SP - 2937
EP - 2945
JO - EUROPEAN JOURNAL OF TRAUMA AND EMERGENCY SURGERY
JF - EUROPEAN JOURNAL OF TRAUMA AND EMERGENCY SURGERY
IS - 6
ER -