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Do superficial infections increase the risk of deep infections in tibial plateau and plafond fractures?

Collaborators (111)

Author information

Affiliations

  • 1. Department of Orthopaedic Surgery, Keck School of Medicine at the University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA, 90033-5322, USA.
      Authors
    • Patterson JT 1
    (1 author)
  • 2. Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
      Authors
    • O'Hara NN 2
    • O'Toole RV 2
    (2 authors)
  • 3. Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA.
      Authors
    • Scharfstein DO 3
    (1 author)
  • 4. Major Extremity Trauma and Rehabilitation Consortium Coordinating Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
      Authors
    • Castillo RC 4
    (1 author)
  • 5. Department of Orthopedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA.
      Authors
    • Firoozabadi R 5
    (1 author)

ORCIDs linked to this article

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European Journal of Orthopaedic Surgery & Traumatology : Orthopedie Traumatologie, 23 Nov 2022, 33(7):2805-2811
https://doi.org/10.1007/s00590-022-03438-1 PMID: 36418579 

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.

Full text links 

Read article at publisher's site: https://doi.org/10.1007/s00590-022-03438-1

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Congressionally Directed Medical Research Programs (1)