Effect of preoperative isolated muscular calf vein thrombosis on the safety and efficacy of open reduction and internal fixation for schatzker type II and III tibial plateau fractures

Abstract

Background Orthopedic surgeons may underestimate the thrombotic risks associated with isolated muscular calf vein thrombosis (IMVT) and its influence on postoperative outcomes. This retrospective cohort study aimed to explore the impact of preoperative IMVT on perioperative safety and clinical efficacy of open reduction and internal fixation (ORIF) for Schatzker type II and III tibial plateau fractures. Methods Patients with Schatzker type II or III tibial plateau fractures receiving ORIF between January 2021 and March 2025 at our institution were consecutively enrolled. Subjects were divided into the study group (patients with preoperative IMVT) and comparison group (patients without preoperative IMVT). Baseline demographics, injury-related data, intraoperative parameters, postoperative VAS pain scores, knee flexion range of motion, and the occurrence of postoperative deep vein thrombosis (DVT) were collected. All patients completed a minimum 6-month follow-up. Results Overall, 242 patients were included. Baseline demographic characteristics, lifestyle factors, laboratory indices, preoperative knee swelling rate and operative duration were comparable between the two groups (all p > 0.05). Postoperative DVT developed in 12 of 17 patients (70.6%) in the study group versus 32 of 225 patients (14.2%) in the comparison group; the difference was statistically significant ( p < 0.05). Among patients with postoperative DVT, non-muscular calf vein thrombosis was identified in 7/12 (58.3%) of the study group and 19/32 (59.4%) of the comparison group. The study group exhibited inferior knee flexion angle at 1 month postoperatively, whereas no intergroup differences in knee flexion were detected at 3 and 6 months after surgery. Conclusion Preoperative isolated muscular calf vein thrombosis is associated with a higher risk of postoperative DVT and impaired short-term recovery of knee flexion function in patients undergoing ORIF for tibial plateau fractures.