Journal article
Is the timing of fixation associated with fracture-related infection among tibial plateau fracture patients with compartment syndrome? A multicenter retrospective cohort study of 729 patients
Injury, Vol.53(11), pp.3814-3819
08/24/2022
DOI: 10.1016/j.injury.2022.08.045
PMID: 36064758
Abstract
Tibial plateau fractures with an ipsilateral compartment syndrome are a clinical challenge with limited guidance regarding the best time to perform open reduction and internal fixation (ORIF) relative to fasciotomy wound closure. This study aimed to determine if the risk of fracture-related infection (FRI) differs based on the timing of tibial plateau ORIF relative to closure of ipsilateral fasciotomy wounds.
A retrospective cohort study identified patients with tibial plateau fractures and an ipsilateral compartment syndrome treated with 4-compartment fasciotomy at 22 US trauma centers from 2009 to 2019. The primary outcome measure was FRI requiring operative debridement after ORIF. The ORIF timing relative to fasciotomy closure was categorized as ORIF before, at the same time as, or after fasciotomy closure. Bayesian hierarchical regression models with a neutral prior were used to determine the association between timing of ORIF and infection. The posterior probability of treatment benefit for ORIF was also determined for the three timings of ORIF relative to fasciotomy closure.
Of the 729 patients who underwent ORIF of their tibial plateau fracture, 143 (19.6%) subsequently developed a FRI requiring operative treatment. Patients sustaining infections were: 21.0% of those with ORIF before (43 of 205), 15.9% at the same time as (37 of 232), and 21.6% after fasciotomy wound closure (63 of 292). ORIF at the same time as fasciotomy closure demonstrated a 91% probability of being superior to before closure (RR, 0.75; 95% CrI, 0.38 to 1.10). ORIF after fasciotomy closure had a lower likelihood (45%) of a superior outcome than before closure (RR, 1.02; 95% CrI; 0.64 to 1.39).
Data from this multicenter cohort confirms previous reports of a high FRI risk in patients with a tibial plateau fracture and ipsilateral compartment syndrome. Our results suggest that ORIF at the time of fasciotomy closure has the highest probability of treatment benefit, but that infection was common with all three timings of ORIF in this difficult clinical situation.
Details
- Title: Subtitle
- Is the timing of fixation associated with fracture-related infection among tibial plateau fracture patients with compartment syndrome? A multicenter retrospective cohort study of 729 patients
- Creators
- Andrew G. Dubina - University of Maryland, BaltimoreGeorge Morcos - University of Maryland School of Medicine, Baltimore, Maryland, USANathan N. O'Hara - Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USAGivenchy W. Manzano - University Hospitals Cleveland Medical Center, Cleveland, Ohio, USAHeather A. Vallier - MetroHealth Medical Center, Cleveland, Ohio, USAHassan Farooq - Department of Orthopaedic Surgery, Indiana University Health, Methodist Hospital, Indianapolis, Indiana, USARoman M. Natoli - Department of Orthopaedic Surgery, Indiana University Health, Methodist Hospital, Indianapolis, Indiana, USADonald Adams - Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USAWilliam T. Obremskey - Vanderbilt University Medical CenterBrandon G. Wilkinson - University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAMatthew Hogue - University of IowaJustin M. Haller - Department of Orthopaedics, University of Utah Hospital, Salt Lake City, Utah, USALucas S. Marchand - Department of Orthopaedics, University of Utah Hospital, Salt Lake City, Utah, USAGavin Hautala - Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky School of Medicine, Lexington, Kentucky, USAPaul E. Matuszewski - University of KentuckyGuillermo R. Pechero - Department of Orthopedic Surgery, UT Health Science Center at Houston, Houston, Texas, USAJoshua L. Gary - Department of Orthopedic Surgery, UT Health Science Center at Houston, Houston, Texas, USAChristopher J. Doro - Department of Orthopedics and Rehabilitation, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USAPaul S. Whiting - Department of Orthopedics and Rehabilitation, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin, USAMichael J. Chen - Stanford Health CareMalcolm R. DeBaun - Department of Orthopaedic Surgery, Stanford Health Care, Stanford, California, USAMichael J. Gardner - Department of Orthopaedic Surgery, Stanford Health Care, Stanford, California, USAAlan W. Reynolds - Allegheny General Hospital, Pittsburgh, Pennsylvania, USAGregory T. Altman - Allegheny General Hospital, Pittsburgh, Pennsylvania, USAMitchel R. Obey - Department of Orthopedic Surgery, Washington University, Saint Louis, Missouri, USAAnna N. Miller - Department of Orthopedic Surgery, Washington University, Saint Louis, Missouri, USADouglas Haase - Department of Orthopaedics, The University of Kansas Health System, Kansas City, Kansas, USABrent Wise - Department of Orthopaedics, The University of Kansas Health System, Kansas City, Kansas, USAAustin Wallace - University of Florida Health, Gainesville, Florida, USAJennifer Hagen - University of Florida Health, Gainesville, Florida, USAJeffrey O'Donnell - Department of Orthopaedic Surgery, Duke University Hospital, Durham, North Carolina, USAMark Gage - Department of Orthopaedic Surgery, Duke University Hospital, Durham, North Carolina, USANicholas R. Johnson - Atrium Health, Charlotte, North Carolina, USAMadhav Karunakar - Atrium Health, Charlotte, North Carolina, USAJoseph Dynako - Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, Jackson, Mississippi, USAJohn Morellato - Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, Jackson, Mississippi, USAZachary A. Panton - Department of Orthopaedics, Dartmouth-Hitchcock Health, Lebanon, New Hampshire, USAI. Leah Gitajn - Department of Orthopaedics, Dartmouth-Hitchcock Health, Lebanon, New Hampshire, USALucas Haase - University Hospitals Cleveland Medical Center, Cleveland, Ohio, USAGeorge Ochenjele - University Hospitals Cleveland Medical Center, Cleveland, Ohio, USAErika Roddy - Department of Orthopaedic Surgery, UCSF Health, San Francisco, California, USASaam Morshed - Department of Orthopaedic Surgery, UCSF Health, San Francisco, California, USAAbigail E. Sagona - Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USATyler D. Caton - Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USAMichael J. Weaver - Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USAJerald R. Westberg - Department of Orthopaedic Surgery, Hennepin Healthcare, Minneapolis, Minnesota, USAJose San Miguel - Department of Orthopaedic Surgery, Hennepin Healthcare, Minneapolis, Minnesota, USARobert V. O'Toole - Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Resource Type
- Journal article
- Publication Details
- Injury, Vol.53(11), pp.3814-3819
- Publisher
- Elsevier Ltd
- DOI
- 10.1016/j.injury.2022.08.045
- PMID
- 36064758
- ISSN
- 0020-1383
- eISSN
- 1879-0267
- Language
- English
- Date published
- 08/24/2022
- Academic Unit
- Orthopedics and Rehabilitation
- Record Identifier
- 9984304715402771
Metrics
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