Outcomes of Nonunion Surgery Following Tibial Plateau Fractures: A Case Series of 28 Patients.

Abstract

To evaluate outcomes of tibial plateau fracture nonunion surgery, including rates of final radiographic healing, additional surgery, and conversion to total knee arthroplasty (TKA). Design: Retrospective case series. Two Level I academic trauma centers. Adult patients who underwent nonunion surgery following open reduction internal fixation (ORIF) of tibial plateau fractures (OTA/AO 41B-C) between 2000 and 2024 were included. The primary outcome was final radiographic healing. Secondary outcomes included additional surgery and conversion to TKA. Twenty-eight patients were included (median age 55 years (IQR: 38-61), 57% male). The median follow-up from the date of the nonunion surgery was 19 months (IQR:13-33). Twenty-one (75%) fractures were classified as Schatzker VI. Nonunion surgery involved revision ORIF in 23 (82%) cases, bone grafting alone (with or without hardware removal) in three (11%) cases, screw augmentation in one (3.6%) patient, and one patient (3.6%) underwent multistage treatment, ending with definitive treatment using an Ilizarov frame for six months. Overall, 54% of patients received bone grafting to address bone defects. Radiographic healing was achieved in 24 patients (86%). All four (14%) patients with a persistent nonunion had Schatzker VI fractures. Of these, three (75%) ultimately underwent conversion to TKA while one had no further surgery until the last follow-up 12.4 months after the initial procedure. Overall, thirteen (46%) patients required additional surgery, of which five (18%) underwent TKA at a median of 3.1 years (IQR: 1.68-6.74). In the current study of patients who underwent tibial plateau fracture nonunion surgery, 86% of patients ultimately achieved radiographic healing, with 71% healed after the index nonunion surgery. Close to half of the patients required additional surgery, with 14% who underwent further procedures to achieve healing, and 18% ultimately required conversion to total knee arthroplasty. These findings can help surgeons counsel patients and guide expectations following surgery for tibial plateau fracture nonunion. Therapeutic Level IV.