Incidence and risk factors for surgical site infection following open reduction and internal fixation of adult tibial plateau fractures

Li, Jia; Zhu, Yanbin; Liu, Bo; Dong, Tieli; Chen, Wei; Zhang, Yingze

doi:10.1007/s00264-017-3729-2

Cited by 44 publications

(39 citation statements)

References 27 publications

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“…Among the complications, SSI was the most common one. Previous literature had reported that SSIs developed at 2-14.2% of patients after they underwent ORIF, half of which were deep infections [5][6][7]. Consequently, patients had to be re-admitted or even re-operated to replace or remove internal fixtures to treat the infection.…”

Section: Introductionmentioning

confidence: 99%

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

Zhu

Zhao

et al. 2020

J Orthop Surg Res

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Background: Surgical site infection (SSI) was the most common complication of tibial plateau fracture after open reduction and internal fixation (ORIF). Severe infections even required repeat surgeries, which would cause serious psychological harm to patients and increased the economic burden of treatment. In order to identify the characteristics of the SSI and to avoid the occurrence of SSI, we conducted a prospective study to investigate the incidence and independent risk factors of SSI after ORIF for closed tibial plateau fractures in adults. Methods: This study was performed at a first-level trauma center. From October 2014 to December 2018, the study subjects were adult patients with closed fractures of the tibial plateau, all of whom underwent open reduction and internal fixation (ORIF) treatment. Finally, a total of 1108 patients were followed up. We collected patient demographics information, surgery-related variables, and indexes from preoperative laboratory examinations. Univariate and multivariate logistic analysis models were used to investigate the potential risk factors. Results: Twenty-five patients (2.3%, 25/1108) developed SSI. A total of 15 of 25 infections (60.0%) were due to Staphylococcus aureus and 3 (12.0%) were due to MRSA. Independent risk factors of SSI identified by multivariate logistic analysis model were bone grafting: autograft (OR 6.38; 95% CI 2.155-18.886; p = 0.001) and allograft (OR 3.215; 95% CI 1.009-10.247; p = 0.048), fracture type (Schartzker V-VI) (OR 8.129; 95% CI 2.961-22.319; p < 0.001), aspartate aminotransferase (>40 U/L) (OR 5.500; 95% CI 2.191-13.807; p < 0.001), white blood cell (>10*10 9 /L) (OR 2.498; 95% CI 1.025-6.092; p = 0.044), and anion gap (>16 mmol/L) (OR 8.194; 95% CI 1.101-60.980). Conclusions: We should pay enough attention to patients who carried one or more of these factors at admission and adopt more reasonable treatment strategies to reduce or avoid the occurrence of SSI.

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Section: Introductionmentioning

confidence: 99%

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

Zhu

Zhao

et al. 2020

J Orthop Surg Res

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“…In the cases of bladder or pelvic diaphragm, the surgical site for the abdomen and pelvis has open communication. Risk factors for orthopedic SSI include prolonged operative duration and open fracture(s) [12,13]. After DCL, the route for the pelvic approach is easily contaminated and, in fact, is expected in long operations for complex fracture(s).…”

Section: Discussionmentioning

confidence: 99%

Feasibility of Early Definitive Internal Fixation of Pelvic Bone Fractures in Therapeutic Open Abdomen

Choi¹,

Keum²,

Kim³

et al. 2020

J Trauma Inj

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Purpose: Damage control laparotomy has contributed to improved survival rates for severe abdominal injuries. A large part of severe abdominal injury occurs with a concomitant pelvic bone fracture. The safety and effectiveness of internal fixation of pelvic bone fracture(s) has not been established. The aim of the present study was to evaluate infection risk in the pelvic surgical site in patients who underwent emergent abdominal surgery. Methods: This single-center retrospective observational study was based on data collected from a prospectively maintained registry between January 2015 and June 2019. Patients who underwent laparotomy and pelvic internal fixation were included. Individuals <18 and ≥80 years of age, those with no microbiological investigations, and those who underwent one-stage abdominal surgery were excluded. Comprehensive statistical comparative analysis was not performed due to the small number of enrolled patients. Results: A total of six patients met the inclusion criteria, and the most common injury mechanism was anterior-posterior compression (67%). The average duration of open abdomen was 98 hours (range, 44-198), and the time interval between abdominal closure and pelvic surgery was 98 hours. One patient (16.7%) died due to multi-organ dysfunction syndrome. Microorganisms were identified in the abdominal surgical site in five patients (83%), with no microorganisms in pelvic surgical sites. There was no unplanned implant removal. Conclusions: Internal fixation of pelvic bone fracture(s) could be performed in the state of open abdomen, and the advantages of early fixation may countervail the risks for cross contamination.

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“…A 2019 meta-analysis including 7925 patients found the incidence of superficial and deep surgical site infections after tibial plateau fracture repairs to be 4.2% and 5.9%, [54][55][56]125], compartment syndrome [27,[54][55][56], smoking [55,56,125], alcohol intake [126], definitive external fixation [56,94] and intraoperative duration approaching 3 h [54,56,125]. A recent article found a strong correlation between a significantly higher peak of C-reactive protein (CRP) >100 μg/ mL on postoperative day 3 and the development of surgical site infections in tibial plateau patients [127].…”

Section: Surgical Site Infectionmentioning

confidence: 99%

Tibial Plateau Fracture

Schmidt¹,

Szatkowski²,

Riehl³

2020

Tibia Pathology and Fractures

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Tibial plateau fractures are a common orthopedic injury. These fractures involve the articular surface of the tibia that is part of the knee joint. Plateau fractures can range from low energy injuries with little or no displacement to complex fractures with significant associated injuries. Stability of these injuries depends on a combination of bony and associated ligamentous injuries. Treatment consists of a wide spectrum of therapies which have been discussed in this chapter. Complications such as compartment syndrome, post-traumatic arthritis, chronic pain, malunion, and wound problems (in addition to other complications) can develop.

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Incidence and risk factors for surgical site infection following open reduction and internal fixation of adult tibial plateau fractures

Cited by 44 publications

References 27 publications

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

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

Feasibility of Early Definitive Internal Fixation of Pelvic Bone Fractures in Therapeutic Open Abdomen

Tibial Plateau Fracture

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