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Updated: Jan 21, 2026
Author Spotlight: Studying Host-Microbe Interactions in Wound Biofilm Formation
Published on: June 16, 2023
Hyperglycemia as a risk factor for postoperative early wound infection after bicondylar tibial plateau fractures:
Andres Rodriguez-Buitrago1, Attum Basem2, Ebubechi Okwumabua3
1Division of Orthopaedic Trauma, Vanderbilt Medical Center, 1215st Avenue South, Nashville, TN, 37212, United States; Universidad del Rosario, School of Medicine and Health Sciences, Bogotá, Colombia.
Objectives:
Identify a glucose threshold that would put patients with isolated bicondylar tibial plateau fractures at risk of early wound infection (i.e. < 90 days).
Design:
Retrospective review of medical records.
Setting:
Academic American College of Surgeons (ACS) Level 1 trauma center.
Patients:
Adult patients between 2010 and 2015 with an operatively treated isolated bicondylar tibial plateau fracture and at least three glucose measurements during their hospitalization.
Main Outcome Measurement:
To predict infection using four different methods: maximum preoperative blood glucose (PBG), maximum blood glucose (MGB), Hyperglycemic Index (HGI), and Time-Weighted Average Glucose (TWAG).
Results:
126/381 patients met our inclusion criteria. Fifteen (12%) patients had an open fracture and 30/126 (23%) developed an infection. Median glucose for each predictive method studied was 114 (IQR 101.2-137.8) mg/dL for PBG, 144 (IQR 119-169.8) mg/dL for MBG, 0.8 (IQR 0.20-1.60) mmol/L for HGI, and 120.4 (IQR 106.0-135.6) mg/dL for TWAG. As expected, infected patients had higher PBG, MGB, and TWAG. HGI was similar in both groups. None of these differences prove to be statistically significant (p > .05). Logistic regression models for all the methods showed that having an open fracture was the strongest predictor of infection.
Conclusion:
It is well known that stress-induced hyperglycemia increases the risk of infection, we present and compare four models that have been used in other medical fields. In our study, none of the methods presented identified a glucose threshold that would increase the risk of infection in patients with bicondylar tibial plateau fractures.
Level Of Evidence:
Retrospective review, Level III. See Instructions for Authors for a complete description of levels of evidence.
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