The Use of Vancomycin Powder in Tibial Plateau Fractures at Lower Risk of Infection

Area of Science:

• Orthopedic surgery
• Infectious disease prevention
• Trauma care

Background:

• Surgical site infections (SSIs) are a significant complication following orthopedic procedures.
• Tibial plateau fractures require surgical fixation, carrying a risk of infection.
• The efficacy of prophylactic antibiotics like vancomycin powder in low-risk fracture populations is not fully established.

Purpose of the Study:

• To evaluate the effectiveness of vancomycin powder in preventing deep surgical site infections (SSIs) after open reduction and internal fixation of tibial plateau fractures.
• To assess the impact of vancomycin powder on gram-positive and gram-negative bacterial infections in this patient cohort.

Main Methods:

• Retrospective cohort study involving 459 patients with tibial plateau fractures (OTA/AO 41-B/C) treated between 2006 and 2018.
• Patients were considered low-risk for infection based on predefined criteria.
• Vancomycin powder was administered at wound closure during definitive internal fixation.

Main Results:

• Vancomycin powder use was associated with a significant reduction in gram-positive SSIs, from 4% to 0% (OR, 0.12; 95% CI, 0.04-0.32; P < 0.01).
• No significant difference in gram-negative infections was observed between groups (0.3% vs. 0.9%).
• Methicillin-resistant Staphylococcus aureus (MRSA) was the most common pathogen in the control group (50% of infections).

Conclusions:

• Vancomycin powder administration at the time of fixation significantly decreased the incidence of gram-positive SSIs in low-risk tibial plateau fracture patients.
• The observed effect in this low-risk group was more pronounced than in previous studies of high-risk patients.
• These findings support considering vancomycin powder prophylaxis for tibial plateau fractures, even in patients deemed low-risk for infection.