Bicondylar Tibial Plateau Fractures: What Predicts Infection?

Abstract

Objectives:The purpose of this study was to identify the patient, injury, and treatment factors associated with infection of bicondylar plateau fractures and to evaluate whether center variation exists.Design:Retrospective review.Setting:Eighteen academic trauma centers.Patients/participants:A total of 1,287 patients with 1,297 OTA type 41-C bicondylar tibia plateau fractures who underwent open reduction and internal fixation were included. Exclusion criteria were follow-up less than 120 days, insufficient documentation, and definitive treatment only with external fixation.Intervention:Open reduction and internal fixation.Main outcome measurements:Superficial and deep infection.Results:One hundred one patients (7.8%) developed an infection. In multivariate regression analysis, diabetes (DM) (OR [odds ratio] 3.24; P ≤ 0.001), alcohol abuse (EtOH) (OR 1.8; P = 0.040), dual plating (OR 1.8; P ≤ 0.001), and temporary external fixation (OR 2.07; P = 0.013) were associated with infection. In a risk-adjusted model, we found center variation in infection rates (P = 0.030).Discussion:In a large series of patients undergoing open reduction and internal fixation of bicondylar plateau fractures, the infection rate was 7.8%. Infection was associated with DM, EtOH, combined dual plating, and temporary external fixation. Center expertise may also play a role because one center had a statistically lower rate and two trended toward higher rates after adjusting for confounders.Level of evidence:Level IV—Therapeutic retrospective cohort study.

Is Staged Surgery Always Necessary for Schatzker Type IV–VI Tibial Plateau Fractures? A Comparison Study

“…Olszewski, Nathan MD, Manzano, and Givenchy MD et al reported in their series that 101/1287 (7.8%) patients developed an infection. They found that temporary external fixation was a risk factor (OR 2.07; p = 0.013) associated with infection [ 14 ]. The current study evaluated the safety and efficacy of early definitive ORIF followed by ciNPT use in Schatzker type IV–VI TPFs compared to staged treatment outcomes.…”

No effect of dislocation status at arrival in emergency department on outcome of knee joint dislocations

“…Data on infections associated with knee dislocation are scarce in the literature, but existing data also report a low rate of infection [10]. However, the rate of surgical site infections is increasing with regard to secondary surgical treatments and potential bony, vascular or nerve interventions and can reach rates of up to 10%, depending on patient-and treatment-related risk factors [20,22]. A higher percentage was reported for posttraumatic cartilage lesions, with 41.7% (n = 50) in our data set.…”