Costs and Complications of Single-Stage Fixation Versus 2-Stage Treatment of Select Bicondylar Tibial Plateau Fractures

J Orthop Trauma. 2018 Jul;32(7):327-332. doi: 10.1097/BOT.0000000000001167.


Objectives: To determine the differences in costs and complications in patients with bicondylar tibial plateau (BTP) fractures treated with 1-stage definitive fixation compared with 2-stage fixation after initial spanning external fixation.

Design: Retrospective cohort study.

Setting: Level 1 Trauma Center.

Patients/participants: Patients with OTA/AO 41-C (Schatzker 6) BTP fractures treated with open reduction internal fixation.

Intervention: Definitive treatment with open reduction internal fixation either acutely (1 stage) or delayed after initial spanning external fixation (2 stage).

Main outcome measures: Wound healing complications, implant costs, hospital charges, Patient-Reported Outcomes Measurement Information System (PROMIS), reoperation, nonunion and infection.

Results: One hundred five patients were identified over a three-year period, of whom 52 met the inclusion criteria. There were 28 patients in the 1-stage group and 24 patients in the 2-stage group. Mean follow-up was 21.8 months, and 87% of patients had at least 12 months of follow-up. The mean number of days to definitive fixation was 1.2 in the 1-stage group and 7.8 in the 2-stage group. There were no differences between groups with respect to wound healing or any other surgery-related complications. Functional outcomes PROMIS were similar between groups. Mean implant cost in the 2-stage group was $10,821 greater than the 1-stage group, mostly because of the costs of external fixation. Median hospital inpatient charges in the 2-stage group exceeded the 1-stage group by more than $68,000 for all BTP fractures and by $61,000 for isolated BTP fractures.

Conclusions: Early single-stage treatment of BTP fractures is cost-effective and is not associated with a higher complication rate than 2-stage treatment in appropriately selected patients.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Female
  • Fracture Fixation, Internal / adverse effects
  • Fracture Fixation, Internal / methods*
  • Fracture Healing / physiology
  • Hospital Costs*
  • Humans
  • Knee Injuries / diagnostic imaging
  • Knee Injuries / surgery
  • Length of Stay / economics
  • Male
  • Menisci, Tibial / surgery*
  • Middle Aged
  • Open Fracture Reduction / adverse effects
  • Open Fracture Reduction / methods*
  • Patient Selection
  • Postoperative Complications / physiopathology
  • Postoperative Complications / surgery
  • Prognosis
  • Reoperation / methods
  • Retrospective Studies
  • Statistics, Nonparametric
  • Tibial Fractures / diagnostic imaging
  • Tibial Fractures / economics
  • Tibial Fractures / surgery*
  • Trauma Centers