Impact of surgical site infection on patients’ outcome after fixation of tibial plateau fractures: a retrospective multicenter study

Abstract

Background Surgical site infection (SSI) occurs in 3–10 % of patients with surgically treated tibial plateau fractures. This study aimed to evaluate the impact of SSI on patients’ outcome after fixation of tibial plateau fractures. Methods We conducted a retrospective multicenter study in seven participating level I trauma centers between January 2005 and December 2014. All participating centers followed up with patients with SSI. In addition, three centers followed up with patients without SSI as a reference group. Descriptive data and follow-up data with patient-reported outcome scores (Knee Injury and Osteoarthritis Outcome Score [KOOS] and Lysholm knee scoring scale score) were evaluated. Results In summary, 287 patients (41 with SSI and 246 without SSI; average 50.7 years) with an average follow-up of 75.9 ± 35.9 months were included in this study. Patients with SSI had a significantly poorer overall KOOS (KOOS5) (48.7 ± 23.2 versus [vs.] 71.5 ± 23.5; p < 0.001) and Lysholm knee scoring scale score (51.4 ± 24.0 vs. 71.4 ± 23.5; p < 0.001) than patients without SSI. This significant difference was also evident in the KOOS subscores for pain, symptoms, activities of daily living (ADL), and quality of life (QoL). SSI remained an important factor in multivariable models after adjusting for potential confounders. Clinically relevant differences in the KOOS5 and KOOS subscores for symptoms, pain, and ADL were found between those with SSI and without SSI even after adjustment. Furthermore, the number of previous diseases, Arbeitsgemeinschaft für Osteosynthesefragen Foundation (AO) C fractures, and compartment syndrome were found to be additional factors related to poor outcome. Conclusions Compared to previous studies, validated patient-reported outcome scores demonstrated that the impact of SSI in patients with surgically treated tibial plateau fractures is dramatic, in terms of not only pain and symptoms but also in ADL and QoL, compared to that in patients without SSI.

Two-level fixation with headless compression screws for tibial plateau fractures

“…An important difference between these studies and our series is that we used a dual incision approach with double plating in 52% of patients (compared to Jansen et al: 14% [ 26 ], Henkelmann. : 14% [ 27 ], Timmers et al: 3% [ 29 ]), which might explain the difference in scores: bivariate analysis in our series demonstrated that patients with bicondylar fractures (and consequently dual incision treatment) reported significantly lower functional outcomes. Another factor that might influence these results is indication bias; we only used HCS for fractures with comminuted, small, and intra-articular fragments in which reduction with standard implants was deemed insufficient.…”

“…They report a mean KOOS score of 68 points (our series median: 60 points). Henkelmann et al evaluated 246 patients with a AO type B and C tibial plateau fractures (without post-operative SSI) after a mean follow-up of 78.9 months [ 27 ]. They report mean KOOS subscores for pain of 75 (our series median: 71), symptoms and stiffness 75 (our series median: 69), ADL 81 (our series median: 85), sports 41 (our series median: 30), and QOL 56 (our series median: 34).…”

“…The most feared short-term complication after tibial plateau fracture surgery is a SSI. These occur in approximately 10% of cases (range 2.6–45.0%; of which deep: 6.4%, superficial: 3.6%), and are associated with worse clinical and patient-reported outcomes [ 27 , 30 ]. In our series, the rate of deep and superficial SSI was 7 and 4%, respectively, and all infections resolved with appropriate treatment.…”

Posteromedial Buttress Plate for Schatzker 6 Fractures as Double Column Fixation

“…It is typically placed through a posteromedial incision and secured to the bone using screws or other fixation devices. The plate is contoured to fit the shape of the bone and is designed to resist the forces that would otherwise cause the fracture to shift or collapse (19) .…”

Editor’s Spotlight/Take 5: Functional Outcome After Nonoperative Management of Tibial Plateau Fractures in Skeletally Mature Patients: What Sizes of Gaps and Stepoffs Can be Accepted?

“…The best estimate I could find of the risk of a devastating surgical site infection after open reduction internal fixation (ORIF) of tibial plateau fractures is about 5% [4], and based on that study's design, it's certain that infections occur even more frequently than that. Patients who develop infections can expect persistent pain and severely impaired function; both in that study [4] and comparing outcomes scores in that study to those in this month's CORR ® article [12], we see that infection reduces Knee Injury and Osteoarthritis Outcome Scores (KOOS) by about 30% to 40%. And not surprisingly, TKAs performed in patients with infection after ORIF of the tibial plateau are much more likely to develop periprosthetic joint infection after the arthroplasty [6].…”