{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,7]],"date-time":"2026-06-07T04:04:44Z","timestamp":1780805084339,"version":"3.54.1"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVES:<\/jats:title>\n                    <jats:p>To evaluate outcomes of tibial plateau fracture nonunion surgery, including rates of final radiographic healing, additional surgery, and conversion to total knee arthroplasty (TKA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Retrospective case series.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>Two Level I academic trauma centers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients:<\/jats:title>\n                    <jats:p>Adult patients who underwent nonunion surgery after open reduction internal fixation of tibial plateau fractures (OTA\/AO 41B-C) between 2000 and 2024 were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome Measures and Comparisons:<\/jats:title>\n                    <jats:p>The primary outcome was final radiographic healing. Secondary outcomes included additional surgery and conversion to TKA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>Twenty-eight patients were included (median age 55 years (IQR: 38\u201361), 57% male). The median follow-up from the date of the nonunion surgery was 19 months (IQR:13\u201333). Twenty-one (75%) fractures were classified as Schatzker VI. Nonunion surgery involved revision open reduction internal fixation in 23 (82%) cases, bone grafting alone (with or without hardware removal) in 3 (11%) cases, screw augmentation in 1 (3.6%) patient, and 1 patient (3.6%) underwent multistage treatment, ending with definitive treatment using an Ilizarov frame for 6 months. Overall, 54% of patients received bone grafting to address bone defects. Radiographic healing was achieved in 24 patients (86%). All 4 (14%) patients with a persistent nonunion had Schatzker VI fractures. Of these, 3 (75%) ultimately underwent conversion to TKA, whereas 1 had no further surgery until the last follow-up 12.4 months after the initial procedure. Overall, 13 (46%) patients required additional surgery, of which 5 (18%) underwent TKA at a median of 3.1 years (IQR: 1.68\u20136.74).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION:<\/jats:title>\n                    <jats:p>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 TKA. These findings can help surgeons counsel patients and guide expectations after surgery for tibial plateau fracture nonunion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LEVEL OF EVIDENCE:<\/jats:title>\n                    <jats:p>Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/bot.0000000000003087","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T18:00:29Z","timestamp":1759255229000},"page":"75-81","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Outcomes of Nonunion Surgery After Tibial Plateau Fractures: A Case Series of 28 Patients"],"prefix":"10.1097","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-5741-9840","authenticated-orcid":false,"given":"Austin T.","family":"Gregg","sequence":"first","affiliation":[{"name":"Harvard Medical School Orthopaedic Trauma Initiative, Boston, MA;"},{"name":"Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7530-3420","authenticated-orcid":false,"given":"Carla H.","family":"Lehle","sequence":"additional","affiliation":[{"name":"Harvard Medical School Orthopaedic Trauma Initiative, Boston, MA;"},{"name":"Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA;"},{"name":"Department of Orthopaedic Surgery, University Medical Center Groningen, Groningen, the Netherlands; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7031-1643","authenticated-orcid":false,"given":"Robert K.","family":"Wagner","sequence":"additional","affiliation":[{"name":"Harvard Medical School Orthopaedic Trauma Initiative, Boston, MA;"},{"name":"Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sikun","family":"Fan","sequence":"additional","affiliation":[{"name":"Harvard Medical School Orthopaedic Trauma Initiative, Boston, MA;"},{"name":"Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3666-6287","authenticated-orcid":false,"given":"Adam N.","family":"Musick","sequence":"additional","affiliation":[{"name":"Harvard Medical School Orthopaedic Trauma Initiative, Boston, MA;"},{"name":"Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4003-1149","authenticated-orcid":false,"given":"Maaz","family":"Muhammad","sequence":"additional","affiliation":[{"name":"Harvard Medical School Orthopaedic Trauma Initiative, Boston, MA;"},{"name":"Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0564-254X","authenticated-orcid":false,"given":"Thomas J.","family":"Policicchio","sequence":"additional","affiliation":[{"name":"Harvard Medical School Orthopaedic Trauma Initiative, Boston, MA;"},{"name":"Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1270-2742","authenticated-orcid":false,"given":"Job N.","family":"Doornberg","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University Medical Center Groningen, Groningen, the Netherlands; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7271-5580","authenticated-orcid":false,"given":"Derek","family":"Stenquist","sequence":"additional","affiliation":[{"name":"Harvard Medical School 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