{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,14]],"date-time":"2026-11-14T10:59:19Z","timestamp":1794653959446,"version":"4.9.1"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:sec><jats:title>Objectives:<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design:<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting:<\/jats:title><jats:p>Level 1 Trauma Center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients\/Participants:<\/jats:title><jats:p>Patients with OTA\/AO 41-C (Schatzker 6) BTP fractures treated with open reduction internal fixation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Intervention:<\/jats:title><jats:p>Definitive treatment with open reduction internal fixation either acutely (1 stage) or delayed after initial spanning external fixation (2 stage).<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures:<\/jats:title><jats:p>Wound healing complications, implant costs, hospital charges, Patient-Reported Outcomes Measurement Information System (PROMIS), reoperation, nonunion and infection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence:<\/jats:title><jats:p>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p><\/jats:sec>","DOI":"10.1097\/bot.0000000000001167","type":"journal-article","created":{"date-parts":[[2018,3,18]],"date-time":"2018-03-18T21:36:04Z","timestamp":1521408964000},"page":"327-332","source":"Crossref","is-referenced-by-count":33,"title":["Costs and Complications of Single-Stage Fixation Versus 2-Stage Treatment of Select Bicondylar Tibial Plateau Fractures"],"prefix":"10.1097","volume":"32","author":[{"given":"Walter W.","family":"Virkus","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse","family":"Caballero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurence B.","family":"Kempton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Cavallero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rich","family":"Rosales","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg E.","family":"Gaski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20230828","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1097\/00005131-200411000-00001","article-title":"Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique","volume":"18","author":"Barei","year":"2004","journal-title":"J Orthop trauma."},{"key":"R2-20230828","first-page":"78","article-title":"Immediate internal fixation of open, complex tibial plateau fractures: treatment by a standard protocol","volume":"6","author":"Benirschke","year":"1992","journal-title":"J Orthop trauma."},{"key":"R3-20230828","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1097\/00005131-199406000-00001","article-title":"Tibial plateau fractures: a study of associated soft tissue injuries","volume":"8","author":"Bennett","year":"1994","journal-title":"J Orthop trauma."},{"key":"R4-20230828","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/0020-1383(95)00027-7","article-title":"The results of surgical management of displaced tibial plateau fractures in the elderly","volume":"26","author":"Biyani","year":"1995","journal-title":"Injury"},{"key":"R5-20230828","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1097\/00003086-198401000-00025","article-title":"Tibial plateau fractures. An analysis of the results of treatment in 60 patients","volume":"182","author":"Blokker","year":"1984","journal-title":"Clin Orthop Relat Res."},{"key":"R6-20230828","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.3928\/0147-7447-20041201-18","article-title":"Open reduction and internal fixation of 117 tibial plateau fractures","volume":"27","author":"Ebraheim","year":"2004","journal-title":"Orthopedics"},{"key":"R7-20230828","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1302\/0301-620X.76B2.8113294","article-title":"Combined anterior and posterior approaches for complex tibial plateau fractures","volume":"76","author":"Georgiadis","year":"1994","journal-title":"J Bone Joint Surg Br."},{"key":"R8-20230828","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/S0020-1383(97)00064-8","article-title":"Functional and radiological outcome after intra-articular tibial plateau fractures","volume":"28","author":"Houben","year":"1997","journal-title":"Injury"},{"key":"R9-20230828","doi-asserted-by":"crossref","first-page":"745","DOI":"10.3928\/0147-7447-19870501-15","article-title":"Tibial plateau fractures. A review of operative treatment using AO technique","volume":"10","author":"Savoie","year":"1987","journal-title":"Orthopedics"},{"key":"R10-20230828","first-page":"94","article-title":"The tibial plateau fracture. The Toronto experience 1968\u20131975","volume":"138","author":"Schatzker","year":"1979","journal-title":"Clin Orthop Relat Res."},{"key":"R11-20230828","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.2106\/00004623-200209000-00006","article-title":"High-energy fractures of the tibial plateau. Knee function after longer follow-up","volume":"84-A","author":"Weigel","year":"2002","journal-title":"J Bone Joint Surg Am."},{"key":"R12-20230828","first-page":"149","article-title":"Complications of internal fixation of tibial plateau fractures","volume":"23","author":"Young","year":"1994","journal-title":"Orthop Rev"},{"key":"R13-20230828","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1097\/01.bot.0000171881.11205.80","article-title":"Staged management of high-energy proximal tibia fractures (OTA types 41): the results of a prospective, standardized protocol","volume":"19","author":"Egol","year":"2005","journal-title":"J Orthop trauma"},{"key":"R14-20230828","first-page":"12","article-title":"Staged management of tibial plateau fractures","volume":"36","author":"Dirschl","year":"2007","journal-title":"Am J Orthop (Belle Mead NJ)."},{"key":"R15-20230828","doi-asserted-by":"crossref","first-page":"2613","DOI":"10.2106\/00004623-200612000-00008","article-title":"Open reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures. Results of a multicenter, prospective, randomized clinical trial","volume":"88","year":"2006","journal-title":"J Bone Joint Surg Am"},{"key":"R16-20230828","first-page":"62","article-title":"Staged management of high-energy proximal tibia fractures","volume":"62","author":"Tejwani","year":"2004","journal-title":"Bull Hosp Jt Dis."},{"key":"R17-20230828","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.jor.2015.02.002","article-title":"Outcomes following the treatment of bicondylar tibial plateau fractures with fine wire circular frame external fixation compared to open reduction and internal fixation: a systematic review","volume":"13","author":"Boutefnouchet","year":"2016","journal-title":"J Orthop."},{"key":"R18-20230828","doi-asserted-by":"crossref","first-page":"7","DOI":"10.5704\/MOJ.1203.006","article-title":"Comparison of outcomes of operatively treated bicondylar tibial plateau fractures by external fixation and internal fixation","volume":"6","author":"Chan","year":"2012","journal-title":"Malays Orthop J."},{"key":"R19-20230828","doi-asserted-by":"crossref","first-page":"1951","DOI":"10.1016\/j.injury.2015.07.018","article-title":"Retrospective review of tibial plateau fractures treated by two methods without staging","volume":"46","author":"Conserva","year":"2015","journal-title":"Injury"},{"issue":"suppl 2","key":"R20-20230828","doi-asserted-by":"crossref","first-page":"74","DOI":"10.2106\/JBJS.G.01165","article-title":"Open reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures. Surgical technique","volume":"91","author":"Hall","year":"2009","journal-title":"J Bone Joint Surg Am."},{"key":"R21-20230828","doi-asserted-by":"crossref","DOI":"10.3928\/01477447-20090624-11","article-title":"Treatment of bicondylar tibia plateau fractures using locked plating versus external fixation","volume":"32","author":"Krupp","year":"2009","journal-title":"Orthopedics"},{"key":"R22-20230828","doi-asserted-by":"crossref","first-page":"661","DOI":"10.2106\/00004623-199505000-00002","article-title":"External fixation and limited internal fixation for complex fractures of the tibial plateau","volume":"77","author":"Marsh","year":"1995","journal-title":"J Bone Joint Surg Am."},{"key":"R23-20230828","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1007\/s00590-014-1528-7","article-title":"High-energy tibial plateau fractures: external fixation versus plate fixation","volume":"25","author":"Yu","year":"2015","journal-title":"Eur J Orthop Surg traumatol."},{"key":"R24-20230828","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1097\/BOT.0000000000000779","article-title":"Is early definitive fixation of bicondylar tibial plateau fractures safe? An observational cohort study","volume":"31","author":"Unno","year":"2017","journal-title":"J Orthop trauma."},{"key":"R25-20230828","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1097\/BOT.0b013e3181d04bc0","article-title":"The results of early primary open reduction and internal fixation for treatment of OTA 43.C-type tibial pilon fractures: a cohort study","volume":"24","author":"White","year":"2010","journal-title":"J Orthop trauma."},{"key":"R26-20230828","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1097\/00005373-198105000-00007","article-title":"Fractures of the tibial plateau: a review of ninety-five patients and comparison of treatment methods","volume":"21","author":"Waddell","year":"1981","journal-title":"J trauma"},{"key":"R27-20230828","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1016\/S0030-5898(20)31955-6","article-title":"High-energy fractures of the tibial plateau","volume":"25","author":"Watson","year":"1994","journal-title":"Orthop Clin North Am"},{"key":"R28-20230828","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/S0030-5898(03)00079-8","article-title":"Open reduction and internal fixation of high-energy tibial plateau fractures","volume":"33","author":"Mills","year":"2002","journal-title":"Orthop Clin North Am."},{"key":"R29-20230828","first-page":"115","article-title":"Early wound complications after operative treatment of high energy tibial plateau fractures through two incisions","volume":"65","author":"Shah","year":"2007","journal-title":"Bull NYU Hosp Jt Dis."},{"key":"R30-20230828","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1186\/s13018-014-0062-y","article-title":"Comparison of outcome of unilateral locking plate and dual plating in the treatment of bicondylar tibial plateau fractures","volume":"9","author":"Lee","year":"2014","journal-title":"J Orthop Surg Res."},{"key":"R31-20230828","first-page":"13","article-title":"Staged columnar fixation of bicondylar tibial plateaus: a cheaper alternative to external fixation","volume":"25","author":"Perdue","year":"2016","journal-title":"J Surg Orthop Adv."},{"key":"R32-20230828","doi-asserted-by":"crossref","first-page":"S32","DOI":"10.1097\/00005131-200409001-00005","article-title":"A staged protocol for soft tissue management in the treatment of complex pilon fractures","volume":"18","author":"Sirkin","year":"2004","journal-title":"J Orthop trauma."},{"issue":"suppl 2","key":"R33-20230828","doi-asserted-by":"crossref","first-page":"S9","DOI":"10.1016\/j.injury.2015.05.025","article-title":"Dual locked plating of unstable bicondylar tibial plateau fractures","volume":"46","author":"Ozkaya","year":"2015","journal-title":"Injury"},{"key":"R34-20230828","first-page":"Rc05","article-title":"Functional and radiological outcome of Schatzker type V and VI tibial plateau fracture treatment with dual plates with minimum 3 years follow-up: a prospective study","volume":"10","author":"Rohra","year":"2016","journal-title":"J Clin diagnostic Res"},{"key":"R35-20230828","doi-asserted-by":"crossref","first-page":"188","DOI":"10.4103\/0019-5413.108915","article-title":"Functional outcome of Schatzker type V and VI tibial plateau fractures treated with dual plates","volume":"47","author":"Prasad","year":"2013","journal-title":"Indian J Orthop."},{"key":"R36-20230828","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1097\/BOT.0b013e318216b1e5","article-title":"Incisional negative pressure wound therapy after high-risk lower extremity fractures","volume":"26","author":"Stannard","year":"2012","journal-title":"J Orthop trauma."},{"key":"R37-20230828","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1016\/j.injury.2015.03.019","article-title":"Outcomes following combined intramedullary nail and plate fixation for complex tibia fractures: a multi-centre study","volume":"46","author":"Yoon","year":"2015","journal-title":"Injury"}],"container-title":["Journal of Orthopaedic Trauma"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/00005131-201807000-00003","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,2]],"date-time":"2024-07-02T03:16:48Z","timestamp":1719890208000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/00005131-201807000-00003"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,7]]},"references-count":37,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2018]]}},"URL":"https:\/\/doi.org\/10.1097\/bot.0000000000001167","relation":{},"ISSN":["0890-5339"],"issn-type":[{"value":"0890-5339","type":"print"}],"subject":[],"published":{"date-parts":[[2018,7]]}}}