Do superficial infections increase the risk of deep infections in tibial plateau and plafond fractures?
Document Type
Article
Publication Date
11-23-2022
Publication Title
European Journal of Orthopaedic Surgery and Traumatology
Abstract
Purpose: Open reduction internal fixation of tibial plateau and pilon fractures may be complicated by deep surgical site infection requiring operative debridement and antibiotic therapy. The management of superficial surgical site infection is controversial. We sought to determine whether superficial infection is associated with an increased risk of deep infection requiring surgical debridement after fixation of tibial plateau and pilon fractures. Methods: This is a secondary analysis of data from the VANCO trial, which included 980 adult patients with a tibial plateau or pilon fracture at elevated risk of infection who underwent open reduction internal fixation with plates and screws with or without intrawound vancomycin powder. An association of superficial surgical site infection with deep surgical site infection requiring debridement surgery and antibiotics was explored after matching on risk factors for deep surgical site infection. Results: Of the 980 patients, we observed 30 superficial infections (3.1%) and 76 deep infections (7.8%). Among patients who developed a superficial infection, the unadjusted incidence of developing a deep infection within 90 days was 12.8% (95% confidence interval [CI] 1.3–24.2%). However, after a 3:1 match on infection risk factors, the 90-day marginal probability of a deep surgical site infection after sustaining a superficial infection was 6.0% (95% CI − 6.5–18.5%, p = 0.35). Conclusion: Deep infection after superficial infection is uncommon following operative fixation of tibial plateau and pilon fractures. Increased risk of subsequent deep infection attributable to superficial infection was inconclusive in these data. Level of evidence: Prognostic Level II.
First Page
2805
Last Page
2811
PubMed ID
36418579
Volume
33
Issue
7
Recommended Citation
Patterson, Joseph T.; O’Hara, Nathan N.; Scharfstein, Daniel O.; Castillo, Renan C.; O’Toole, Robert V.; Firoozabadi, Reza; McAndrew, Christopher M.; Gardner, Michael J.; Miller, Anna N.; Spraggs-Hughes, Amanda; Osborn, Patrick M.; Rivera, Jessica C.; Murray, Clinton K.; Kimmel, Joseph E.; Bosse, Michael J.; Hsu, Joseph R.; Karunakar, Madhav A.; Seymour, Rachel B.; Sims, Stephen H.; Churchill, Christine; Reilly, Rachel M.; Zura, Robert D.; Howes, Cameron; Weaver, Michael J.; Wagstrom, Emily A.; Westberg, Jerald R.; Lee, Olivia C.; Krause, Peter C.; Rowe, Cara J.; and al, et, "Do superficial infections increase the risk of deep infections in tibial plateau and plafond fractures?" (2022). School of Medicine Faculty Publications. 3764.
https://digitalscholar.lsuhsc.edu/som_facpubs/3764
10.1007/s00590-022-03438-1