Management of aseptic nonunions of bicondylar tibial plateau fractures

PURPOSE: Nonunion of bicondylar tibial plateau (BTP) fractures following open reduction internal fixation (ORIF) is rare but challenging. We report a case series of aseptic BTP nonunions, approaches to treatment, and long-term outcomes.

METHODS: Retrospective case series of aseptic nonunion in operatively treated BTP fractures. Cases with deep infection prior to a revision were excluded. Demographic, injury, and initial fixation characteristics were collected. Clinical course following diagnosis of nonunion was reviewed. Revision operation characteristics, timing, and outcomes were recorded.

RESULTS: 13 patients with aseptic nonunion were identified from 508 BTP fractures. Mean (SD) follow-up was 5.2 years (4.6) from the first revision operation for nonunion. Nine patients underwent revision ORIF, which led to union in 6/9 cases. Two patients had total knee arthroplasty (TKA) performed as the initial revision operation for nonunion. One patient was treated with bone grafting without revision of implants and one patient was lost to follow-up after diagnosis of nonunion. Three patients subsequently had TKA performed following failed revision ORIF. In total 5/13 patients underwent TKA.

CONCLUSIONS: Revision ORIF of aseptic nonunion of a BTP fracture often leads to successful union. However, TKA may be utilized in select cases and at a higher rate than in primary tibial plateau fractures.