Subchondral rafting wires reduce tibial plateau fracture subsidence

Joseph T Patterson; Daniel Rusu; Andrew M Duong; Vivek Satish; Max Yang; Lucas Mayer; Michael Allen; Geoffrey S Marecek

doi:10.1007/s00590-024-03963-1

Subchondral rafting wires reduce tibial plateau fracture subsidence

Eur J Orthop Surg Traumatol. 2024 May 9. doi: 10.1007/s00590-024-03963-1. Online ahead of print.

Authors

Joseph T Patterson¹, Daniel Rusu², Andrew M Duong², Vivek Satish², Max Yang², Lucas Mayer², Michael Allen², Geoffrey S Marecek³

Affiliations

¹ Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA, 90033-5322, USA. josephp7@usc.edu.
² Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA, 90033-5322, USA.
³ Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA.

PMID: 38720055
DOI: 10.1007/s00590-024-03963-1

Abstract

Purpose: To determine if subchondral rafting wires retained as adjunctive tibial plateau fracture fixation affect postoperative articular subsidence.

Methods: A retrospective cohort study was conducted at one Level 1 trauma center and one academic university hospital. Consecutive adults with closed, displaced OTA/AO 41B/C tibial plateau fractures treated between 2018 and 2023 with open reduction internal fixation were included. Patients who were not ambulatory, with contralateral injuries limiting weight bearing, and without follow-up radiographs of the injured extremity were excluded. The intervention was retention of subchondral rafting wires as definitive fixation. The primary outcome was linear articular surface subsidence between postoperative and follow-up AP knee radiographs. Linear subsidence was compared between groups using Welch's two sample t test. Associations of linear subsidence with patient, injury, and treatment characteristics were assessed by multivariable linear regression.

Results: We identified 179 patients of a mean age of 44 ± 14 years, of whom 15 (8.4%) received subchondral rafting wires. Median follow-up was 121 days. No patients who received rafting wires as definitive implants experienced linear subsidence ≥ 2 mm, while 22 patients (13.4%) who did not receive rafting wires experienced linear subsidence ≥ 2 mm (p = 0.130). Subchondral rafting wires were associated with less linear subsidence (0.3 mm [95% confidence interval - 0.3-0.9 mm] vsersus 1.0 mm [- 0.9-2.9 mm], p < 0.001). The depth of linear subsidence was significantly associated on multivariable regression with male sex, depressed plateau area, active smoking, and retained rafting wires.

Conclusion: Subchondral rafting wires were associated with a small reduction in articular subsidence after internal fixation of tibial plateau fractures. Routine rafting wires may be useful for patients and fractures at high risk of articular subsidence.

Keywords: Fracture; Open reduction internal fixation; Rafting wires; Subsidence; Tibial plateau.