Bicondylar Tibial Plateau Fractures: What Predicts Infection?. Issue 20 (15th October 2022)

• Record Type: Journal Article
• Authors: Olszewski, Nathan; Manzano, Givenchy; Wilson, Eleanor; Joseph, Noah; Vallier, Heather; Pawlak, Amanda; Kottmeier, Stephen; Miller, Adam; Gary, Joshua; Namm, Joshua; Miller, Anna; Gupte, Guarang; Rodriguez-Buitrago, Andre; Obremskey, William; Willier, Donald; Marcantonio, Andrew; Phieffer, Laura; Sheridan, Elizabeth; Li, Katerine; Karunakar, Madhav; Vargas-Hernandez, Juan; Yuan, Brandon; Shapiro, Joshua; Pratson, Lincoln; Friess, Darin; Jenkins, David; Leighton, Ross; Alqudhaya, Rashed; Aljilani, Waael; Mullis, Brian; Gruenwald, Konstantin; Ollivere, Benjamin; Myint, Yulanda; Odom, Christopher; Spitler, Clay; Suwak, Patrik; Shah, Sagar; Rocha, Daniela; Horwitz, Daniel; Tornetta, Paul;
• Is Part Of: Journal of the American Academy of Orthopaedic Surgeons. Volume 30:Issue 20(2022)
• Page Start: e1311
• Page End: e1318
• Publication Date: 2022-10-15
• Subjects: Orthopedics -- Periodicals; Orthopedic surgery -- Periodicals; Joint Diseases -- Periodicals; Orthopedics -- Periodicals; Orthopedic surgery; Orthopedics; Periodicals; 616.7005
• DOI: 10.5435/JAAOS-D-21-00432
• Languages: English
• ISSNs: 1067-151X

Abstract

Abstract : Objectives: The purpose of this study was to identify the patient, injury, and treatment factors associated with infection of bicondylar plateau fractures and to evaluate whether center variation exists. Design: Retrospective review. Setting: Eighteen academic trauma centers. Patients/participants: A total of 1, 287 patients with 1, 297 OTA type 41-C bicondylar tibia plateau fractures who underwent open reduction and internal fixation were included. Exclusion criteria were follow-up less than 120 days, insufficient documentation, and definitive treatment only with external fixation. Intervention: Open reduction and internal fixation. Main outcome measurements: Superficial and deep infection. Results: One hundred one patients (7.8%) developed an infection. In multivariate regression analysis, diabetes (DM) (OR [odds ratio] 3.24; P ≤ 0.001), alcohol abuse (EtOH) (OR 1.8; P = 0.040), dual plating (OR 1.8; P ≤ 0.001), and temporary external fixation (OR 2.07; P = 0.013) were associated with infection. In a risk-adjusted model, we found center variation in infection rates ( P = 0.030). Discussion: In a large series of patients undergoing open reduction and internal fixation of bicondylar plateau fractures, the infection rate was 7.8%. Infection was associated with DM, EtOH, combined dual plating, and temporary external fixation. Center expertise may also play a role because one center had a statistically lower rate and two trended toward higher rates after adjusting for confounders. Level of evidence: Level IV—Therapeutic retrospective cohort study.