Objectives: 

To compare the risk of deep infection and unplanned reoperation after staged open reduction internal fixation (ORIF) of bicondylar tibial plateau (BTP) fractures whether elements of the temporizing external fixator were prepped into the surgical field or completely removed before definitive fixation.

Design: 

Retrospective comparative cohort study.

Setting: 

Two academic Level 1 trauma centers.

Patients/Participants: 

One hundred forty-seven OTA/AO 41-C (Schatzker 6) BTP fractures treated with a 2-stage protocol of acute spanning ex-fix followed by definitive ORIF between 2001 and 2018.

Intervention: 

Seventy-eight fractures had retained elements of the original ex-fix prepped in situ during surgery for definitive internal fixation, and 69 had the ex-fix construct completely removed before prepping and draping.

Main Outcome Measures: 

Deep infection and unplanned reoperation.

Results: 

Among 147 patients treated with staged ORIF, the overall deep infection rate was 26.5% and the reoperation rate was 33.3%. There were high rates of deep infection (26.9% vs. 26.1%, P = 0.909) and unplanned reoperation (30.8% vs. 36.2%, P = 0.483) in both groups, but no difference whether the ex-fix was prepped in or completely removed. Within the retained ex-fix group, there was no difference in infection with retention of the entire ex-fix compared with only the ex-fix pins (28.1% vs. 26.1%, P = 0.842).

Conclusions: 

We observed high complication rates in this cohort of OTA/AO 41C BTP fractures treated with staged ORIF, but prepping in the ex-fix did not lead to a significant increase in rates of infection or reoperation. This study provides the treating surgeon with clinical data about a common practice used to facilitate definitive fixation of unstable BTP fractures.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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胫骨高原双髁骨折分期 ORIF 期间原位准备外固定器是否安全？回顾性比较队列研究

目标： 

比较双髁胫骨平台 (BTP) 骨折分期切开复位内固定 (ORIF) 后深部感染和非计划再手术的风险，无论临时外固定器的元件是否已准备好进入手术区域或在最终固定前完全移除。

设计： 

回顾性比较队列研究。

环境： 

两个学术一级创伤中心。

患者/参与者： 

147 例 OTA/AO 41-C (Schatzker 6) BTP 骨折在 2001 年至 2018 年期间采用急性跨越前固定的 2 阶段方案治疗，然后是明确的 ORIF。

干涉： 

78 例骨折保留了在手术期间原位准备的原始前固定元件以进行最终内固定，69 例在准备和悬垂之前完全去除了前固定结构。

主要观察指标： 

深度感染和计划外再次手术。

结果： 

分期ORIF治疗的147例患者中，总体深部感染率为26.5%，再手术率为33.3%。两组的深部感染率（26.9% vs. 26.1%，P = 0.909）和计划外再次手术（30.8% vs. 36.2%，P = 0.483）的发生率都很高，但无论是预先修​​复还是预先修复没有差异完全删除。在保留的 ex-fix 组中，与仅保留 ex-fix 针相比，保留整个 ex-fix 的感染没有差异（28.1% 对 26.1%，P = 0.842）。

结论： 

我们观察到这组 OTA/AO 41C BTP 骨折采用分期 ORIF 治疗的并发症发生率很高，但在前固定中进行准备并没有导致感染率或再手术率显着增加。这项研究为治疗外科医生提供了有关用于促进不稳定 BTP 骨折最终固定的常见做法的临床数据。

证据等级： 

治疗级别 III。有关证据级别的完整描述，请参见作者说明。