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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.
Objectives:
To determine whether early definitive fixation of tibial plateau fractures (TPF) was associated with a lower risk of deep surgical-site infection (SSI) compared with delayed fixation.
Methods:
Data Sources: PubMed, Cochrane, Web of Science, Embase, and Google Scholar were searched for English-language studies from January 1, 2010, through December 12, 2025. Study Selection: Comparative studies evaluating early versus delayed definitive fixation of Schatzker I-VI and/or AO/OTA 41B-C TPFs with infection and/or postoperative complications included. Data Extraction: ROBINS-I assessed bias. Data Synthesis: Early fixation was fixation within 72 hours of injury or before fasciotomy closure. The primary outcome was deep SSI, with subgroup analyses by timing threshold (<24 hours, <72 hours, <5 days), fracture pattern, and fasciotomy status. Secondary outcomes included superficial infection, overall infection, wound complications, and reoperation using the <72-hour definition of early fixation. Random-effects risk ratios (RRs) with 95% confidence intervals, event rates, and subgroup differences were reported. Between-study heterogeneity was assessed using I2.
Results:
Nine studies (n = 1,412) were included. Demographic-reporting studies included 668 early fixation (weighted age 46.1 years; 70.1% male) and 582 delayed fixation patients (weighted age 47.9 years; 67.9% male). Age ranges were not uniformly reported by fixation group. Early fixation within 72 hours had lower deep SSI risk (8.7% vs 16.1%; RR 0.54; P = 0.04). Deep SSI did not differ using <24-hour (10.8% vs 12.9%; RR 0.60; P = 0.13) or <5-day thresholds (7.8% vs 14.5%; RR 0.60; P = 0.26). No subgroup interaction was identified by timing threshold (P = 0.64) or fracture pattern (P = 0.92). Overall infection was lower after early fixation (14.0% vs 19.6%; RR 0.59; P = 0.02). Superficial infection (3.4% vs 4.3%), wound dehiscence (7.5% vs 2.9%), wound necrosis (7.5% vs 7.1%), and reoperation (16.9% vs 20.8%) did not differ significantly (RRs 0.63-2.47; all P ≥ 0.09).
Conclusions:
Early definitive fixation of tibial plateau fractures was associated with lower pooled risk of deep SSI and overall infection compared with delayed fixation, without increased complications. However, these findings should be interpreted cautiously and do not establish causality.
Level Of Evidence:
Level III.