Risk Factors for Infection in Patients Undergoing Osteosynthesis for Tibial Plateau Fracture in a University Hospital.

Abstract

Schatzker types IV to VI tibial plane fractures compromise the two tibial plateaus. Most cases involve joint deviation and require anatomic reduction and rigid fixation. Dual access and prolonged surgical time are factors that exert an influence on the occurrence of infection of the surgical wound and, consequently, the clinical outcome. The reason why these fractures have a greater incidence of infection compared to others remains unclear. The aim of the present study was to investigate risk factors for infection in patients undergoing osteosynthesis for tibial plateau fracture considering demographic, clinical, and operative factors.A retrospective study was conducted with data on patients with Schatzker types IV, V, and VI tibial plateau fracture submitted to surgical treatment at a tertiary university hospital affiliated with the public healthcare system. The following data were extracted from the patient files: age; type of fracture; mechanisms of trauma; exposure of fracture; use of external fixator prior to osteosynthesis considering the time of fixator use, distance between Schanz screws, and location of the fracture; presence of compartment syndrome; number of surgical accesses; surgical time; number of participants in surgery and smoking; and comparing groups with and without infection at the surgical site in the immediate postoperative period (up to three weeks). Among the 44 patients studied, mean age was 48.5±15.1 years, 72.7% patients were male, 11.4% were diabetic, 56.8% had Schatzker type V tibial fracture, 88.6% had fractures caused by high-impact trauma, 95.5% of the fractures were closed, 100% used an external fixator prior to definitive osteosynthesis, 54.5% had a single lateral surgical access, and infection at the surgical site occurred in 25% of patients. In the comparison of patients with and without infection, a significant difference was found regarding the distance between the Schanz screws and location of the fracture (p=0.0286), which was shorter in patients with infection at the surgical site. The analysis of potential risk factors for infection revealed that open fracture was the only risk factor in patients with proximal tibial fracture, with a 1.22-fold increase in the likelihood of infection (odds ratios {OR}: 1.22; 95% confidence intervals {CI}: 0.93-1.62; p=0.012). In conclusion, open fracture, greater proximity between the Schanz screws of the external fixator, and the location of the fracture were considered risk factors for infection at the surgical site in patients undergoing osteosynthesis for tibial plateau fracture.