JOT - 2026-05-05 - Journal Article
What is the Rate of Occult Vessel Abnormalities in High-Energy Tibial Plateau Fractures (OTA/AO 41)?
Zhang D, Eurich J, Pitz-Goncalves L, Schimizzi G, Erdman MK, Christiano A
Topics
Key Takeaway
Occult non-atherosclerotic vascular abnormalities were detected by CTA in 11.5% of high-energy tibial plateau fractures, but none required vascular intervention and abnormalities did not correlate with wound complications (p=0.47).
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Summary
This prospective cohort study at a single Level I trauma center enrolled adults with high-energy tibial plateau fractures (OTA/AO 41) without clinical vascular indications who underwent knee-spanning external fixation followed by protocolized CTA. CTA identified non-atherosclerotic vascular abnormalities in 3 of 26 patients (11.5%), including two popliteal and one anterior tibial artery disruptions, none of which required intervention. Wound complication rates did not differ significantly between patients with and without vascular abnormalities (33.3% vs. 16.7%, p=0.47).
Key Limitation
The study is severely underpowered with only 26 patients and 3 vascular abnormality events, making the negative correlation finding statistically unreliable and insufficient to definitively guide practice.
Original Abstract
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.