Incidence and Outcomes of Vascular Injury in the Setting of Tibial Plateau Fractures: A Single-Center Review

Concern for vascular injury in the setting of tibial plateau fractures is a common consultation to the vascular surgery service. There is no algorithm to predict the likelihood of vascular injury based on fracture type or injury characteristics. The purpose of this study was to determine the incidence of vascular injury in patients with various types of tibial plateau fractures and clinical characteristics on presentation to guide management. This was a single-center retrospective review of consecutive patients with tibial plateau fractures in 2014. The trauma database was queried for International Classification of Diseases-Ninth Revision codes for tibial fractures. A reviewer blinded to the outcomes determined the fracture type using the Schatzker classification system (Fig). Patient demographics, clinical presentation, and outcomes were abstracted. A total of 178 patients (52% male; mean age, 49 years; range, 15-98 years) with tibial plateau fractures were identified during the study period. The tibial plateau injuries were classified as Schatzker type I in 2 (1%), type II in 55 (31%), type III in 4 (2%), type IV in 17 (10%), type V in 38 (21%), and type VI in 62 (35%). Vascular studies obtained included the ankle-brachial index in 87 (49%), arterial duplex imaging in 21 (13%), computed tomography angiography in 16 (9%), and arteriogram in 2 (1%). The incidence of vascular injury was only 2% (n = 4). Three of the four patients (Schatzker types II, IV, and VI) presented with Rutherford IIB ischemia and had successful revascularization. The remaining patient (type VI) was managed nonoperatively with a viable limb in the setting of an anterior tibial artery thrombosis. All patients needing revascularization presented with sensory deficits, motor deficits, and no palpable pulse. Isolated findings of a nonpalpable pulse (n = 9 [5%]), sensory deficit (n = 6 [3%]), or motor deficits (n = 16 [9%]) were not predictive of vascular injury (Table). Schatzker types I, III, and V also had no vascular injuries. Vascular injury associated with tibial plateau fracture is a rare event (2%) and when it occurs, it is apparent (Rutherford IIb ischemia). A detailed physical examination can likely identify clinically significant vascular injury, obviating the need for additional costly or urgent diagnostic studies. Further prospective studies are needed to correlate fracture patterns that may be associated with vascular injury.TableCorrelation of physical examination findings with the presence of vascular injuryExam findingsNo vascular injury (n = 174)Vascular injuryNo operative intervention (n = 1)With revascularization (n = 3)No palpable pulse, % (No.)5 (9)0 (0)100 (3)Sensory deficits, % (No.)3 (6)0 (0)100 (3)Motor deficits, % (No.)9 (16)0 (0)100 (3) All 3 Findings0 (0)0 (0)100 (3) Open table in a new tab