Locking Plate Fixation in a Series of Bicondylar Tibial Plateau Fractures Raises Treatment Costs Without Clinical Benefit

Objectives To compare outcomes and costs between locking and nonlocking (NL) constructs in the treatment of bicondylar tibial plateau (BTP) fractures. Design Retrospective cohort study. Setting Level 1 academic trauma center. Patients All patients who presented with complete articular, BTP fractures OTA/AO 41-C and Schatzker VI between 2013 and 2015 were screened (n = 112). Patients treated with a mode of fixation other than plate-and-screw were excluded. Fifty-six patients with a minimum follow-up of 12 months were included in the analysis. Intervention Operative fixation of BTP fractures with locking (n = 29) or NL (n = 27) implants. Main outcome measurements Implant cost, patient-reported outcomes (PROMIS physical function and pain interference), clinical, and radiographic outcomes. Results There were no differences between the 2 groups with respect to demographics, injury characteristics, radiographic outcomes (change in alignment), or clinical outcomes (PROMIS, reoperation, nonunion, and infection). Implant costs were significantly greater in the locking group compared with the NL group (mean L, $4453; mean NL, $2569; P Conclusions This study demonstrated improved value of treatment (less cost with no difference in clinical outcome) with NL implants for BTP fractures when dual-plate fixation strategies are performed. Level of evidence Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.