What is the Rate of Occult Vessel Abnormalities in High-Energy Tibial Plateau Fractures (OTA/AO 41)?

OBJECTIVES: The aim of this study was to determine the rate of occult vascular abnormalities in high-energy tibial plateau fractures using computed tomography angiography (CTA). METHODS . Design: Prospective Cohort Study. Setting: Single Academic Level I Trauma Center. Patient Selection Criteria: Adult patients with a tibial plateau (OTA/AO 41) fracture, without clinical indication for CTA, that underwent knee-spanning external fixation were prospectively enrolled. Outcome Measures and Comparisons: After external fixation, patients underwent CTA to evaluate fracture morphology and the vascular tree. Fisher exact test was used to determine correlations between arterial abnormalities and wound complications in patients with ≥90 days of follow-up. RESULTS: A total of 26 patients with 27 high-energy tibial plateau fractures were enrolled. Patients were predominantly male (n = 16, 61.5%) with a mean age of 45.1 ± 13.3 years. All patients had a blunt injury mechanism resulting in mostly closed (n = 25, 92.6%), bicondylar (n = 22, 81.5%) tibial plateau fractures. CTA demonstrated nonatherosclerosis vascular abnormalities in 3 patients (11.5%). Two had disrupted flow in the popliteal artery, and 1 had disrupted flow in the anterior tibial artery. No patient required vascular intervention. Atherosclerosis was appreciated in 6 (26.9%) patients. One of 3 patients (33%) with nonatherosclerosis vascular abnormalities had wound complications. Four of 24 patients (16.7%) without nonatherosclerosis vascular abnormalities had wound complications. There was no significant correlation between nonatherosclerosis vascular abnormalities and wound complications (abnormality present: 33.3% wound complication rate vs. no abnormality: 16.7%, P = 0.47). CONCLUSIONS: Non atherosclerotic vascular abnormalities on CTA were found in approximately a 10th of high-energy tibial plateau fractures. In this cohort, vascular abnormalities were not associated with wound complications. CTA is likely not necessary in patients with tibial plateau fracture without clinical indications for CTA. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.