Septic tibial plateau nonunion leads to poor outcomes and frequent salvage procedures: A long-term cohort study - 26/08/26
Abstract |
Background |
Septic nonunion of tibial plateau fractures is an exceptionally rare and severe complication for which long-term outcomes and the need for definitive salvage procedures are poorly documented. The juxta-articular location, limited bone stock, and frequent soft-tissue compromise make management particularly challenging, even in specialised centres.
Hypothesis |
It was hypothesised that most patients with septic nonunion of the tibial plateau ultimately require non-reconstructive salvage procedures and experience poor long-term functional outcomes.
Methods |
A retrospective cohort study was conducted at a national referral centre for complex osteoarticular infections (CRIOAC). All adults treated for septic nonunion of the tibial plateau between 2002 and 2023 were included, with a minimum follow-up of two years. Septic nonunion was defined by absent healing after ≥6 months combined with microbiologically confirmed deep infection according to Fracture-Related Infection (FRI) criteria. Demographic data, fracture characteristics, microbiology, surgical management, and long-term outcomes were collected. The primary outcome was the rate and type of non-reconstructive salvage procedures (arthrodesis, transfemoral amputation, or delayed total knee arthroplasty). Functional outcomes (KSS, KOOS, VAS, range of motion) were assessed when applicable.
Results |
Twenty-eight patients were included (mean age 45 ± 15 years; mean follow-up 8.1 ± 6.3 years). Only 5 of 28 patients (18%) achieved both union and infection remission without salvage surgery. Salvage procedures were required in 23 of 28 patients (82%), including total knee arthroplasty in 14 (50%), femorotibial arthrodesis in 4 (14%), and transfemoral amputation in 5 (18%). Persistent infection at final follow-up was recorded in 6 of 28 patients (21%). Functional outcomes were generally poor, with KSS 46.1 ± 12.2 and KOOS 41.4 ± 9.6 among patients retaining a mobile joint. Numerical trends suggested that diabetes, immunosuppression, open fractures, and polymicrobial infection may be associated with failure.
Conclusion |
Septic nonunion of the tibial plateau is associated with extremely limited reconstructive potential and a high likelihood of salvage procedures, even within a specialised multidisciplinary centre. These results provide essential data for prognosis assessment and transparent patient counselling in this complex clinical scenario.
Level of evidence |
IV; retrospective cohort study.
Le texte complet de cet article est disponible en PDF.Keywords : Tibial fractures, Tibial plateau fracture, Infected tibial nonunion, Tibial nonunion, Internal fixation, Salvage procedures: above knee amputation or knee arthrodesis
Plan
Vol 112 - N° 5
Article 104658- septembre 2026 Retour au numéro
Article précédent
- Bone defect size and healing outcomes in femoral and tibial fracture-related bone defects treated with the Masquelet technique
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