The application of allgöwer-donati suture in obese patients with closed Schatzker type V and VI tibial plateau fractures.

Abstract

To evaluate the efficacy of the Allgöwer-Donati suture in obese patients with closed Schatzker type V and VI tibial plateau fractures. A total of 83 eligible patients treated between October 2024 and February 2026 were enrolled. Patients were stratified by body mass index (BMI) and suture technique into four groups: Obese-Experimental,n = 17,Obese-Control,n = 18,Normal-Experimental,n = 24, and Normal-Control, n = 24. Outcomes included a modified ASEPSIS score (defined as the highest daily score during postoperative days 1-7（AP1-7） and days 7-14（AP7-14）), which has not been formally validated and should be interpreted as exploratory, VAS pain scores on days 3, 7, and 14, and SF-36 physical health domain scores at 12 weeks. Baseline characteristics were comparable across the four groups. All surgeries were completed uneventfully. For AP1-7 scores, the obese group had significantly higher scores than the normal-weight group (mean difference 1.63, 95% CI: 0.39-2.88, P = 0.011), while the experimental group had lower scores than the control group (P = 0.055). Two-way ANOVA revealed a significant main effect of BMI group (P = 0.006). The number needed to treat (NNT) was 5 in the obese group and 12 in the normal-weight group. For AP7-14 scores, the obese group also had significantly higher scores than the normal-weight group (P = 0.011), with no difference between suture technique groups (P = 0.090). Two-way ANOVA again showed a significant main effect of BMI group (P = 0.006). VAS scores decreased significantly over time in all groups (all P < 0.001), with no between-group differences. No significant differences were observed in any SF-36 domain across the four groups (all P > 0.05). Wound complications were limited to transient erythema, exudate, and fat liquefaction, all of which resolved with enhanced dressing changes or bedside debridement. No deep or superficial infections or long-term complications occurred. Obese patients with closed Schatzker type V and VI tibial plateau fractures have a significantly higher rate of short-term postoperative wound complications than their normal-weight counterparts.In this exploratory study, the Allgöwer-Donati suture was associated with a reduction in short-term wound complications. Subgroup analysis suggested a potential benefit in obese patients, although limited statistical power warrants confirmation in larger studies. Both suture techniques yield favorable long-term wound healing.