Risk of Surgical Site Infections in OTA/AO Type C Tibial Plateau and Tibial Plafond Fractures: A Systematic Review and Meta-Analysis

Bullock, Travis S; Ornell, Samuel S.; Naranjo, Jose M G; Morton-Gonzaba, Nicholas; Ryan, Patrick B.; Petershack, Matthew; Salazar, Luis M.; Moreira, Álvaro; Zelle, Boris A.

doi:10.1097/bot.0000000000002259

Cited by 12 publications

(7 citation statements)

References 34 publications

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“…A recent systematic review of 3158 type 43C fractures reported an overall 9.1% deep infection rate, though did not stratify for acute versus staged fixation, and significant heterogeneity existed between included publications (I 2 = 0.55). 18 The results of this study parallel the results of more recent literature and systematic reviews. In this study, we report an overall deep infection rate of 9.2%, with 8.6% and 10% rates in staged versus acute fixation (P = 0.99).…”

Section: Discussionsupporting

confidence: 85%

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Outcomes After Acute Versus Staged Fixation of Complete Articular Tibial Plafond Fractures

Flanagan

Lufrano

Mesa

et al. 2023

Journal of Orthopaedic Trauma

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Participants: 98 skeletally mature patients with OTA/AO 43C type fractures who underwent definitive fixation with plate and screw constructs and had a minimum 6 months of follow-up.Intervention: Acute open reduction internal fixation (aORIF) versus staged (sORIF) definitive fixation.Main Outcome Measurement: Rates of wound dehiscence/ necrosis and deep infection.Results: Acute (N = 40) versus staged (N = 58) ORIF groups had comparable rates of vascular disease, renal disease, and substance/ nicotine use, but aORIF patients had higher rates of diabetes mellitus (10% vs. 0%, P , 0.001), which correlated with higher American Society of Anaesthesiologist scores (.American Society of Anaesthesiologist 3: 37.5% vs. 13.8%, P = 0.02). Both groups achieved anatomic/good reductions, as determined by postoperative CT scans, at rates greater than 90%; however, the sORIF group required modestly longer operative times to achieve this outcome (aORIF vs. sORIF: 121 vs. 146 minutes, P = 0.02). Postoperatively, both groups had similar rates of wound dehiscence (2.5% vs. 6.9%, P = 0.65), superficial infections (10% vs. 17.2%, P = 0.39), and deep infections (10% vs. 8.6%, P = 0.99). While the injury pattern itself required free flap coverage in 1 patient in each group, unplanned free flap coverage occurred in 10.0% and 10.3% of aORIF and sORIF groups, respectively. Overall, rates of unplanned reoperations, excluding ankle arthrodesis, did not differ between groups (aORIF vs. sORIF:12.5% vs. 25.9%, P = 0.13). Conclusions:In select patients managed by fellowship-trained orthopaedic traumatologists, acute definitive pilon fixation can produce acceptable outcomes.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Outcomes After Acute Versus Staged Fixation of Complete Articular Tibial Plafond Fractures

Flanagan

Lufrano

Mesa

et al. 2023

Journal of Orthopaedic Trauma

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“…In 2000 patients treated with ORIF by henkelman et al in 2020, the rate of surgical site infection was 4.7% (93/2000) (56). In 2022, the rate of deep infection in OTA/AO type C tibial plateau reported by Bullock et al was 6% (57).…”

Section: Infectionmentioning

confidence: 99%

Complications of the surgical treatment of fractures of the tibial plateau: prevalence, causes, and management

2022

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Open reduction and internal fixation is the gold standard treatment for tibial plateau fractures. However, the procedure is not free of complications such as knee stiffness, acute infection, chronic infection (osteomyelitis), malunion, non-union, and post-traumatic osteoarthritis. The treatment options for knee stiffness are mobilisation under anaesthesia (MUA) when the duration is less than 3 months, arthroscopic release when the duration is between 3 and 6 months, and open release for refractory cases or cases lasting more than 6 months. Early arthroscopic release can be associated with MUA. Regarding treatment of acute infection, if the fracture has healed, the hardware can be removed, and lavage and debridement can be performed along with antibiotic therapy. If the fracture has not healed, the hardware is retained, and lavage, debridement, and antibiotic therapy are performed (sometimes more than once until the fracture heals). Fracture stability is important not only for healing but also for resolving the infection. In cases of osteomyelitis, treatment should be performed in stages: aggressive debridement of devitalised tissue and bone, antibiotic spacing and temporary external fixation until the infection is resolved (first stage), followed by definitive surgery with grafting or soft tissue coverage depending on the bone defect (second stage). Intra-articular or extra-articular osteotomy is a good option to correct malunion in young, active patients without significant joint damage. When malunion is associated with extensive joint involvement or the initial cartilage damage has resulted in knee osteoarthritis, the surgical option is total knee arthroplasty.

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“…A recently published systematic review and meta-analysis of 182 published studies estimated the overall incidence of postoperative infection to be 15% with a 95% confidence interval of 13%-17%. 27 Thus, a baseline infection rate of 15% was assumed for calculation of cost savings for our health economic model. In addition, a second health economic model with a more conservative 13% SSI rate as a reference was created.…”

Section: Statistical Analysis and Health Economic Modelmentioning

confidence: 99%

“…Using this incremental cost of infection treatment, the additional cost of infection treatment per patient was calculated using the respective infection rates of 7.4% in the iNPWT group from this study, versus 13%, 15%, 17%, which were assumed for patients without iNPWT, based on the systematic review and meta-analysis of 182 studies. 27 The cost of iNPWT was estimated using the average contract price of $495 for a 3M Prevena Peel and Place System Kit (3M). Categorical variables were compared using x 2 or Fisher exact tests.…”

Section: Statistical Analysis and Health Economic Modelmentioning

confidence: 99%

How Can Negative Pressure Wound Therapy Pay for Itself?—Reducing Complications Is Important

Zelle

Kore

2022

Journal of Orthopaedic Trauma

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Introduction: Orthopaedic trauma demonstrates a relatively high rate of surgical site infections (SSI) as compared with other surgical specialties. SSIs provide significant clinical challenges and create significant health care costs. Incisional negative pressure wound therapy (iNPWT) has reduced the risk of SSI in orthopaedic surgery and other surgical specialties. Purpose:The purpose of this study is to investigate potential cost savings with the use of iNPWT (3M Prevena Therapy, 3M, St. Paul, MN) in high-risk orthopaedic trauma patients with closed OTA/AO 41C and 43C fractures.Methods: This is a retrospective cohort study performed at a single, level-1 trauma center using data from a lower extremity fracture registry. Using the results from the registry and baseline infection rates derived from the literature, a health economic model was developed to evaluate the potential cost savings.Results: A total of 79 patients included in the registry underwent open reduction and internal fixation of OTA/AO 41C and 43C fractures. A total of 10.1% developed a SSI. For those who received iNPWT, the rate of SSI was 7.4%. A health economic model suggests that the use of iNPWT may reduce the costs per patient by approximately $1381 to $4436 per patient. Conclusions:This health economic assessment and model suggests that judicious use of iNPWT may reduce health care costs in patients undergoing open reduction and internal fixation of OTA/AO 41C and 43C fractures.

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Risk of Surgical Site Infections in OTA/AO Type C Tibial Plateau and Tibial Plafond Fractures: A Systematic Review and Meta-Analysis

Cited by 12 publications

References 34 publications

Outcomes After Acute Versus Staged Fixation of Complete Articular Tibial Plafond Fractures

Outcomes After Acute Versus Staged Fixation of Complete Articular Tibial Plafond Fractures

Complications of the surgical treatment of fractures of the tibial plateau: prevalence, causes, and management

How Can Negative Pressure Wound Therapy Pay for Itself?—Reducing Complications Is Important

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