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Early Definitive Fixation and Risk of Deep Surgical-Site Infection After Tibial Plateau ORIF: A Systematic Review and
Justin Le1, Katherine Xie1, Benjamin Hershfeld2,3,4
1Rowan-Virtua School of Osteopathic Medicine, Stratford, NJ.
Journal of Orthopaedic Trauma
|June 19, 2026
Summary
Early fixation of tibial plateau fractures (TPF) within 72 hours significantly reduces the risk of deep surgical-site infection (SSI) and overall infection compared to delayed fixation. This approach did not increase other complications.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
- Infectious Disease Prevention
Background:
- Deep surgical-site infection (SSI) is a significant complication following tibial plateau fracture (TPF) treatment.
- The optimal timing for definitive fracture fixation remains a subject of debate, impacting patient outcomes.
Purpose of the Study:
- To evaluate the association between early definitive fixation and the risk of deep SSI in patients with TPF.
- To compare early versus delayed fixation strategies regarding infection and other postoperative complications.
Main Methods:
- A systematic review and meta-analysis of comparative studies published between 2010 and 2025.
- Included studies compared early (<72 hours) versus delayed fixation for Schatzker I-VI and AO/OTA 41B-C TPFs.
- Primary outcome was deep SSI; secondary outcomes included superficial infection, wound complications, and reoperation.
Main Results:
- Nine studies (n=1,412) were analyzed. Early fixation (<72 hours) was associated with a significantly lower risk of deep SSI (8.7% vs. 16.1%; RR 0.54; P=0.04).
- Overall infection rates were also lower with early fixation (14.0% vs. 19.6%; RR 0.59; P=0.02).
- No significant differences were observed in superficial infections, wound dehiscence, necrosis, or reoperation rates between early and delayed fixation groups.
Conclusions:
- Early definitive fixation of tibial plateau fractures (<72 hours) is linked to reduced risks of deep SSI and overall infection.
- The findings suggest early fixation is a safe and potentially beneficial strategy, though causality requires further investigation.