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

OBJECTIVES: To determine the rate of occult vascular abnormalities in high-energy tibial plateau fractures using Computed Tomography Angiography (CTA). DESIGN: Prospective Cohort Study. SETTING: Single Academic Level I Trauma Center. PATIENT SELECTION CRITERIA: Adult subjects 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: Following external fixation, subjects underwent CTA to evaluate fracture morphology and the vascular tree. Fisher's exact test was utilized to determine correlations between arterial abnormalities and wound complications in patients with ≥90 days of follow-up. RESULTS: Twenty-six subjects with 27 high-energy tibial plateau fractures were enrolled. Subjects 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 non-atherosclerosis vascular abnormalities in three patients (11.5%). Two had disrupted flow in the popliteal artery, and one had disrupted flow in the anterior tibial artery. No subjects required vascular intervention. Atherosclerosis was appreciated in six (26.9%) subjects. One of three subjects (33%) with non-atherosclerosis vascular abnormalities had wound complications. Four of 24 subjects (16.7%) without non-atherosclerosis vascular abnormalities had wound complications. There was no significant correlation between non-atherosclerosis 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 tenth of high-energy tibial plateau fractures. In this cohort, vascular abnormalities were not associated with wound complications. CTA is likely not necessary in tibial plateau fracture patients without clinical indications for CTA. LEVEL OF EVIDENCE: Level II.