Incidence and risks for surgical site infection after closed tibial plateau fractures in adults treated by open reduction and internal fixation: a prospective study

Li, Junyong; Zhu, Yanbin; Zhao, Kuo; Zhang, Junzhe; Meng, Hongyu; Jin, Zhucheng; Ma, Jiangtao; Zhang, Yingze

doi:10.1186/s13018-020-01885-2

Cited by 18 publications

(21 citation statements)

References 33 publications

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“…No significant differences were found between patients with and without infection regarding age, time between trauma and care, duration of external fixator, duration of surgery, or number of participants involved in the surgical procedure. This differs from findings reported in previous studies regarding the duration of fixator use and duration of surgery [ 2 , 7 , 13 ]. According to the literature, each additional hour of surgery increases the risk of surgical site infection in the postoperative period by approximately 78% [ 6 , 7 ].…”

Section: Discussioncontrasting

confidence: 99%

“…In the analysis of potential risk factors for infection in patients with tibial plateau fracture, open fracture was the only variable that significantly increased the likelihood of infection in the immediate postoperative period (OR: 1.22; 95% CI: 0.93-1.62; p=0.012). This finding is in agreement with data reported in the literature [ 2 , 7 , 13 , 14 ]. It should be pointed out that, while open fracture contributes to the occurrence of infection, it cannot be controlled by the medical team.…”

Section: Discussionsupporting

confidence: 94%

“…Surgical site infection occurs in 9.9% of cases of osteosynthesis for tibial plateau fracture [ 2 ] and is a determinant of an unsatisfactory outcome due to the need for further surgical interventions to identify the infectious agent and perform the mechanical cleansing of the fracture, which lengthens the hospital stay and increases treatment costs by as much as 300% [ 8 , 12 ]. The main factors that favor infection in this type of osteosynthesis are open fracture, fracture type (Schatzker V/VI), compartment syndrome, smoking, diabetes, and the presence of an external fixator prior to surgery [ 2 , 3 , 13 ]. In the present series of 44 patients with tibial plateau fracture operated by the same surgical team, acute surgical site infection occurred in 11 (25%) patients.…”

Section: Discussionmentioning

confidence: 99%

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Risk Factors for Infection in Patients Undergoing Osteosynthesis for Tibial Plateau Fracture in a University Hospital

Forni¹,

Fraga²,

Jalikj³

2022

Cureus

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Schatzker types IV to VI tibial plane fractures compromise the two tibial plateaus. Most cases involve joint deviation and require anatomic reduction and rigid fixation. Dual access and prolonged surgical time are factors that exert an influence on the occurrence of infection of the surgical wound and, consequently, the clinical outcome. The reason why these fractures have a greater incidence of infection compared to others remains unclear. The aim of the present study was to investigate risk factors for infection in patients undergoing osteosynthesis for tibial plateau fracture considering demographic, clinical, and operative factors. A retrospective study was conducted with data on patients with Schatzker types IV, V, and VI tibial plateau fracture submitted to surgical treatment at a tertiary university hospital affiliated with the public healthcare system. The following data were extracted from the patient files: age; type of fracture; mechanisms of trauma; exposure of fracture; use of external fixator prior to osteosynthesis considering the time of fixator use, distance between Schanz screws, and location of the fracture; presence of compartment syndrome; number of surgical accesses; surgical time; number of participants in surgery and smoking; and comparing groups with and without infection at the surgical site in the immediate postoperative period (up to three weeks). Among the 44 patients studied, mean age was 48.5±15.1 years, 72.7% patients were male, 11.4% were diabetic, 56.8% had Schatzker type V tibial fracture, 88.6% had fractures caused by high-impact trauma, 95.5% of the fractures were closed, 100% used an external fixator prior to definitive osteosynthesis, 54.5% had a single lateral surgical access, and infection at the surgical site occurred in 25% of patients. In the comparison of patients with and without infection, a significant difference was found regarding the distance between the Schanz screws and location of the fracture (p=0.0286), which was shorter in patients with infection at the surgical site. The analysis of potential risk factors for infection revealed that open fracture was the only risk factor in patients with proximal tibial fracture, with a 1.22-fold increase in the likelihood of infection (odds ratios {OR}: 1.22; 95% confidence intervals {CI}: 0.93-1.62; p=0.012). In conclusion, open fracture, greater proximity between the Schanz screws of the external fixator, and the location of the fracture were considered risk factors for infection at the surgical site in patients undergoing osteosynthesis for tibial plateau fracture.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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Risk Factors for Infection in Patients Undergoing Osteosynthesis for Tibial Plateau Fracture in a University Hospital

Forni¹,

Fraga²,

Jalikj³

2022

Cureus

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“…Secondly, previous studies have mostly focused on a specific part. These parts have a high risk of postoperative infection, such as the tibia, ankle joint, and calcaneus [ 16 , 17 , 21 , 22 ]. Finally, due to the large number of variables in the clinical and microbial characteristics of the patients, we excluded medical records with missing data.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and microbiology of fracture-related infection: a multicenter study in Northeast China

Wang

Xiao

Zhang³

et al. 2021

J Orthop Surg Res

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Objective This study aimed to explore the epidemiological and microbiological characteristics of fracture-related infection (FRI), analyze the drug resistance characteristics of major pathogens, and provide timely and relatively complete clinical and microbiological data for antimicrobial treatment of FRI. Methods The clinical and microbiological data of patients with FRI from January 1, 2011, to December 31, 2020, were collected from three tertiary hospitals in Northeast China. The automatic microbial analysis system was used for strain identification and drug susceptibility testing, and the drug susceptibility results were determined in accordance with the latest Clinical and Laboratory Standards Institute (CLSI) criteria (as applicable each year). Results A total of 744 patients with FRI were enrolled. The incidence of FRI was about 1.5%, and 81.7% were male patients, with an average age of 48.98 ± 16.01 years. Open fractures accounted for 64.8%. Motor crush (32.8%) and falling (29.8%) were the main causes of injuries. The common sites of infection were the tibia and fibula (47.6%), femur (11.8%), foot (11.8%), and hand (11.6%). A total of 566 pathogenic bacteria were cultured in 378 patients with positive bacterial cultures, of which 53.0% were Gram-positive bacteria and 47.0% were Gram-negative bacteria. The most common pathogen at all sites of infection is Staphylococcus aureus. Staphylococcus aureus had a high resistance rate to penicillin (PEN), erythromycin (ERY), and clindamycin (CLI), exceeding 50%. Methicillin-resistant Staphylococcus aureus (MRSA) was more than 80% resistant to CLI and ERY. Conclusions The incidence of FRI in Northeast China was at a low level among major medical centers nationwide. Staphylococcus aureus was still the main pathogen causing bone infections, and the proportion of MRSA was lower than reported abroad, but we have observed an increase in the proportion of infections. Enterobacteriaceae have a higher resistance rate to third-generation cephalosporins and quinolones. For Enterobacteriaceae, other sensitive treatment drugs should be selected clinically.

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“…In this study, AST levels in the SSI group were significantly higher than in the non-SSI group (23.5 versus 21.0 p = 0.038). Consistently, Li et al [15] demonstrated that AST is a risk factor for SSI after closed tibial plateau fractures. Fractures are widely acknowledged to be accompanied by soft tissue injury.…”

Section: Discussionmentioning

confidence: 69%

Development of a nomogram to predict surgical site infection after closed comminuted calcaneal fracture

Huang

Mao

et al. 2022

BMC Surg

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Background Compared with open comminuted calcaneal fractures, less emphasis is placed on postoperative surgical site infection (SSI) of closed comminuted calcaneal fractures. This study aimed to identify the risk factors associated with SSI and build a nomogram model to visualize the risk factors for postoperative SSI. Methods We retrospectively collected patients with closed comminuted calcaneal fractures from the Second Affiliated Hospital of Wenzhou Medical University database from 2017 to 2020. Risk factors were identified by logistics regression analysis, and the predictive value of risk factors was evaluated by ROC (receiver operating characteristic curve). Besides, the final risk factors were incorporated into R4.1.2 software to establish a visual nomogram prediction model. Results The high-fall injury, operative time, prealbumin, aspartate aminotransferase (AST), and cystatin-C were independent predictors of SSI in calcaneal fracture patients, with OR values of 5.565 (95%CI 2.220–13.951), 1.044 (95%CI 1.023–1.064), 0.988 (95%CI 0.980–0.995), 1.035 (95%CI 1.004–1.067) and 0.010 (95%CI 0.001–0.185) (Ps < 0.05). Furthermore, ROC curve analysis showed that the AUC values of high-fall injury, operation time, prealbumin, AST, cystatin-C, and their composite indicator for predicting SSI were 0.680 (95%CI 0.593–0.766), 0.756 (95%CI 0.672–939), 0.331 (95%CI 0.243–0.419), 0.605 (95%CI 0.512–0.698), 0.319 (95%CI 0.226–0.413) and 0.860 (95%CI 0.794–0.926), respectively (Ps < 0.05). Moreover, the accuracy of the nomogram to predict SSI risk was 0.860. Conclusions Our study findings suggest that clinicians should pay more attention to the preoperative prealbumin, AST, cystatin C, high-fall injury, and operative time for patients with closed comminuting calcaneal fractures to avoid the occurrence of postoperative SSI. Furthermore, our established nomogram to assess the risk of SSI in calcaneal fracture patients yielded good accuracy and can assist clinicians in taking appropriate measures to prevent SSI.

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Incidence and risks for surgical site infection after closed tibial plateau fractures in adults treated by open reduction and internal fixation: a prospective study

Cited by 18 publications

References 33 publications

Risk Factors for Infection in Patients Undergoing Osteosynthesis for Tibial Plateau Fracture in a University Hospital

Risk Factors for Infection in Patients Undergoing Osteosynthesis for Tibial Plateau Fracture in a University Hospital

Epidemiology and microbiology of fracture-related infection: a multicenter study in Northeast China

Development of a nomogram to predict surgical site infection after closed comminuted calcaneal fracture

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