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Bicondylar Tibial Plateau Fractures: What Predicts Infection?

Nathan Olszewski1, Givenchy Manzano, Eleanor Wilson

  • 1From the Boston Medical Center, Boston, MA, (Olszewski, Tornetta III), MetroHealth Medical Center , Cleveland, OH, (Manzano, Wilson, Joseph, Vallier), Stony Brook University, Setauket- East Setauket, NY, (Pawlak, Kottmeier), University of Houston, Houston, TX, (Adam Miller, Gary), Washington University, St. Louis, MO, (Namm, Anna Miller, Gupte), Vanderbilt University Medical Center, Nashville, TN, (Rodriguez-Buitrago, Obremskey), the Division of Orthopaedic Surgery Lahey Hospital & Medical Center, Burlington, MA, (Willier III, Marcantonio), The Ohio State Wexner Medical Center, Columbus, OH, (Phieffer, Sheridan), Carolinas Medical Center, Charlotte, NC, (Li, Karunakar), Mayo Clinic, Rochester, MN, (Vargas-Hernandez, Yuan), the Department of Orthopaedics (Shapiro, Pratson), University of North Carolina, Chapel Hill, NC, Oregon Health & Science University, Portland, OR, (Friess, Jenkins), Dalhousie University-Halifax, Canada, (Leighton, Alqudhaya, Aljilani), Indiana University Orthopedics, Indianapolis, IN, (Mullis, Gruenwald), Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom, (Ollivere, Myint), University Alabama Birmingham, Birmingham, AL, (Odom, Spitler), LSUHSC Department of Orthopaedic Surgery, New Orleans, LA, (Suwak, Shah), and the Geisinger Musculoskeletal Institute, Danville, PA (Rocha, Horwitz).

The Journal of the American Academy of Orthopaedic Surgeons
|October 6, 2022
PubMed
Summary

Infection after bicondylar plateau fracture surgery is 7.8%. Diabetes, alcohol abuse, dual plating, and external fixation increase infection risk. Center variation in outcomes suggests expertise matters.

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Area of Science:

  • Orthopedic Surgery
  • Trauma Surgery
  • Infection Control

Background:

  • Bicondylar tibia plateau fractures are complex injuries requiring surgical fixation.
  • Postoperative infection is a significant complication, impacting patient outcomes.
  • Identifying risk factors and understanding treatment variations are crucial for improving care.

Purpose of the Study:

  • To identify patient, injury, and treatment factors associated with infection after bicondylar plateau fracture fixation.
  • To investigate potential variations in infection rates across different treatment centers.

Main Methods:

  • Retrospective review of 1,287 patients with OTA type 41-C bicondylar tibia plateau fractures.
  • Patients underwent open reduction and internal fixation (ORIF).
  • Multivariate regression analysis was used to identify risk factors for infection.

Main Results:

  • The overall infection rate was 7.8% (101 patients).
  • Significant risk factors for infection included diabetes (DM), alcohol abuse (EtOH), dual plating, and temporary external fixation.
  • A statistically significant variation in infection rates was observed among the 18 participating academic trauma centers.

Conclusions:

  • Diabetes, alcohol abuse, dual plating, and temporary external fixation are associated with increased infection risk following ORIF of bicondylar plateau fractures.
  • Center-specific expertise may influence infection rates, highlighting the importance of specialized care.
  • Further research into center-specific protocols could help mitigate infection risks.