Impression fracture of the lateral condyle of tibial plateau complicated by acute peri-implant infection: a case report

Abstract

Introduction. Deep infection after open osteosynthesis of tibial plateau fractures occurs in 9.9%. This rate is significantly higher than in surgical treatment of closed injuries of other localizations. Many foreign authors consider it necessary to improve protocols for the management of patients with comminuted plateau fractures in order to minimize or prevent the development of infection. Aim of the study is to discuss the treatment tactics of a patient with an intra-articular fracture of the tibial plateau after osteosynthesis, complicated by the development of early deep surgical site infection. Clinical case. A 71-year-old patient with compromised somatic status underwent osteosynthesis with a buttress plate and allogeneic bone grafting of the metaphyseal defect on the 12th day after injury. In 7 days after the occurrence of signs of infection, a revision surgery was performed. Later, a number of consecutive revisions were performed due to recurrences of the infectious process. The complex of measures against surgical site infection included the use of vacuum drainage systems and antibacterial spacers. Two years after the injury the wounds healed. The patient had a good functional result. Discussion. There are several approaches to the management of infection after osteosynthesis: wound debridement and retention of the implant, replacement of one implant with another, and removal of the implant with conversion to external fixation. Surgical treatment is mandatory if a surgical site infection after primary surgery occurs. Several consecutive interventions can be performed. Wound closure after revision is performed either with the installation of an active drainage system or the wound is closed with a VAC-system. The use of local antibacterial therapy in the form of antibacterial spacers reduces the rate of recurrent infection from 18.7% without their use to 10% of cases with their use. Conclusion. Successful treatment of infectious complications of osteosynthesis requires a team of like-minded specialists, which should include general practitioners, microbiologists, and clinical pharmacologists in addition to an orthopedic surgeon. To prevent such complications, it is important to reduce injury rate and improve the quality of primary osteosynthesis.