When It’s OK To Do Acute ORIF for High-energy Tibial Plateau Fractures

Acute (rather than staged) ORIF of high-energy plateau fractures may be safe in certain settings — here's how to pick 'em

Smart Practice: An experienced fracture surgeon may consider acute (rather than staged) ORIF if patients have no blistering/necrosis, contaminated/severe open fractures, compartment syndrome, tobacco use, or advanced age.

What’s the Claim?

Among patients with high-energy Schatzker IV, V, and VI fractures, a retrospective, comparative study found that early, definitive ORIF in selected patients:

  • Was possible in 84% of the patients they treated, based on the Unno criteria (more on this below)
  • Was associated with no increase in the risk of wound complications compared to a typical delayed ORIF approach (though patients in both groups were more likely to experience these complications if they were older or if they smoked cigarettes)
  • Facilitated more efficient care — four fewer days in the hospital, on average, and lower costs

How’s It Stack Up?