Is It Safe to Prep the External Fixator In Situ During Staged ORIF of Bicondylar Tibial Plateau Fractures? A Retrospective Comparative Cohort Study

Stenquist, Derek S; Yeung, Caleb M.; Guild, Theodore; Weaver, Michael J.; Harris, Mitchel B.; Keudell, Arvind G. von

doi:10.1097/bot.0000000000002334

Cited by 2 publications

(3 citation statements)

References 31 publications

(84 reference statements)

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“…The literature on prepping in the Ex-Fix during definitive ORIF is limited. Perhaps, the most similar study to this one is a recently published retrospective comparative cohort study assessing complications after staged ORIF of bicondylar tibial plateau fractures, and Stenquist et al 10 found that despite finding high overall deep infection and unplanned reoperation rates, there was no association with whether the Ex-Fix was prepped in or completely removed. In that study, the patients were divided into 2 groups: those who had any retained elements of the original Ex-Fix, including at least one intraosseous pin, prepped into the sterile field during definitive ORIF, and those who had the entire Ex-Fix removed.…”

Section: Discussionmentioning

confidence: 89%

“…8 Despite advocates for both strategies, the evidence for either approach is limited. 9,10 The primary aim of this study is to assess the rate of FRI and unplanned reoperation when disinfecting and prepping in the Ex-Fix during definitive internal fixation of pilon fractures treated by a staged protocol. The secondary aim is to determine whether the amount of time from external fixation to ORIF influences the risk of FRI.…”

Section: Introductionmentioning

confidence: 99%

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Safety of Prepping the External Fixator In Situ During Staged Internal Fixation of Pilon Fractures: A Retrospective Comparative Cohort Study

Yeramosu

Young

Cinats

et al. 2023

Journal of Orthopaedic Trauma

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Objective: (1) To assess the rate of fracture-related infection (FRI) and unplanned reoperation of disinfecting and prepping in the external fixator (Ex-Fix) instrument during definitive open reduction and internal fixation (ORIF) of pilon fractures treated by a staged protocol and (2) to determine whether the amount of time from external fixation to ORIF influences the risk of FRI. Design: Retrospective cohort study. Setting: Level 1 academic trauma center. Patients: One hundred thirty-three patients who underwent operative treatment for pilon fracture between 2010 and 2020. Intervention: External fixation and ORIF with or without the Ex-Fix prepped in situ during definitive fixation. Main Outcome Measurements: FRI and unplanned reoperation rates. Results: 133 patients were enrolled, of which 47 (35.3%) had Ex-Fix elements prepped in situ. There was an overall infection rate of 23.3% and unplanned reoperation rate of 11.3%, and there was no significant difference in rates between the 2 cohorts. Patients with Ex-Fix elements prepped in situ who developed an FRI had a higher rate of MRSA and MSSA. Diabetes (P = 0.0019), open fracture (P = 0.0014), and longer (≥30 days) interval to ORIF (P = 0.0001) were associated with postoperative FRI. Conclusions: Prepping elements of the Ex-Fix in situ did not lead to an increase in rates of FRI or unplanned reoperation. Although diabetes and open fracture were associated with FRI risk, a stronger association was a longer interval of Ex-Fix utilization before definitive internal fixation, specifically 30 days or greater. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Safety of Prepping the External Fixator In Situ During Staged Internal Fixation of Pilon Fractures: A Retrospective Comparative Cohort Study

Yeramosu

Young

Cinats

et al. 2023

Journal of Orthopaedic Trauma

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“…A survey of 50 surgeons frequently treating closed fractures of extremities demonstrated that 86% of surgeons prefer the complete removal of the external fixator prior to sterile preparation and draping [ 2 ]. Multiple studies have shown that prepping the external fixator for tibial plateau fractures is safe and does not infer an additional infection risk [ 3 , 4 ]. However, the benefits, if any, of sterilely including the external fixator in the surgical field on postoperative outcomes are not well documented.…”

Section: Introductionmentioning

confidence: 99%

Maintenance of an Intraoperative External Fixator Is Associated With Decreased Postoperative Stiffness After Definitive Management of High-Energy Tibial Plateau Fractures

Speybroeck¹,

Moon²,

Haase³

et al. 2023

Cureus

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Introduction Postoperative stiffness is a common complication after high-energy tibial plateau fractures. Investigation into reported surgical techniques for the prevention of postoperative stiffness is limited. The purpose of this study was to compare the rates of postoperative stiffness after second-stage definitive surgery for high-energy tibial plateau fractures between groups of patients who had the external fixator prepped into the surgical field and those who did not. Methods Two hundred forty-four patients met the inclusion criteria between the two academic Level I trauma centers, representing the retrospective observational cohort. Patients were separated based on prepping of the external fixator into the surgical field during second-stage definitive open reduction and internal fixation. One hundred sixty-two patients were in the prepped group and 82 were in the non-prepped group. Post-operative stiffness was determined by the need to return to the operating room for subsequent procedures. Results At the final follow-up (mean = 14.6 months), patients in the non-prepped group had an increased rate of stiffness post-operatively (18.3% non-prepped versus 6.8% prepped; p = 0.006). No other investigated variables were associated with increased post-operative stiffness, including the number of days spent in the fixator and operative time. The relative risk for post-operative stiffness associated with complete fixator removal was 2.54 (95% CI 1.26-4.41; p = 0.008 on binary logistic regression; absolute risk reduction 11.5%). Conclusion At the final follow-up, maintenance of an intraoperative external fixator as a reduction aid was associated with a clinically significant decrease in post-operative stiffness after definitive management of high-energy tibial plateau fractures, when compared with complete removal prior to prepping.

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Is It Safe to Prep the External Fixator In Situ During Staged ORIF of Bicondylar Tibial Plateau Fractures? A Retrospective Comparative Cohort Study

Cited by 2 publications

References 31 publications

Safety of Prepping the External Fixator In Situ During Staged Internal Fixation of Pilon Fractures: A Retrospective Comparative Cohort Study

Safety of Prepping the External Fixator In Situ During Staged Internal Fixation of Pilon Fractures: A Retrospective Comparative Cohort Study

Maintenance of an Intraoperative External Fixator Is Associated With Decreased Postoperative Stiffness After Definitive Management of High-Energy Tibial Plateau Fractures

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