Application of ERAS concept in treatment of tibial plateau fractures with minimally invasive double reverse tractions

Abstract

Objective: To evaluate the application of ERAS concept in the treatment of tibial plateau fractures with minimally invasive double reverse tractions (MIDRT). Methods: A retrospective study was conducted of the 39 patients with tibial plateau fracture who had been treated at Department of Orthopedics, Union Hospital from February 2018 to June 2020. They were 20 males and 19 females, aged from 27 to 47 years. All cases were treated with the same MIDRT but with different perioperative management protocols. Of them, 20 received conventional perioperative management (control group) and 19 perioperative ERAS management (ERAS group). The 2 groups was compared in terms of visual analogue scale (VAS) at 24 hours postoperation, drainage volume, time for removal of drainage tube, hospital stay, patient's satisfaction, incidence of complications, and American Special Surgery Hospital (HSS) scores at discharge and 1, 3, 6 and 9 months postoperation. Results: There was no significant difference in the preoperative general data between the 2 groups, showing comparability between groups (P>0.05). All cases obtained complete follow-up (mean, 10.9 months). No statistically significant difference was found between the 2 groups in drainage volume, time for removal of drainage tube or HSS scores at discharge or one month after discharge (P>0.05). The VAS score at 24 hours after operation, hospital stay [(9.4±4.8) d], patient's satisfaction, HSS scores [(90.8±3.8), (93.5±4.3) and (95.6±3.7)] in the ERAS group were significantly better than those in the control group [(13.3±1.9) d, (87.5±5.1), (88.1±4.4) and (88.8±4.4)] (P<0.05). None of the patients had such serious complications as wound infection, breakage or failure of internal fixation, or fracture nonunion. Conclusion: The perioperative management protocols designed according to the ERAS concept may enhance the clinical efficacy of MIDRT in the treatment of tibial plateau fractures and thus raise the patient's satisfaction.