Bicondylar Tibial Plateau Fractures: What Predicts Infection?

Nathan Olszewski, Givenchy Manzano, Eleanor Wilson, Noah Joseph, Heather Vallier, Amanda Pawlak, Stephen Kottmeier, Adam Miller, Joshua Gary, Joshua Namm, Anna Miller, Guarang Gupte, Andre Rodriguez-Buitrago, William Obremskey, Donald Willier, Andrew Marcantonio, Laura Phieffer, Elizabeth Sheridan, Katerine Li, Madhav KarunakarJuan Vargas-Hernandez, Brandon Yuan, Joshua Shapiro, Lincoln Pratson, Darin Friess, David Jenkins, Ross Leighton, Rashed Alqudhaya, Waael Aljilani, Brian Mullis, Konstantin Gruenwald, Benjamin Ollivere, Yulanda Myint, Christopher Odom, Clay Spitler, Patrik Suwak, Sagar Shah, Daniela Rocha, Daniel Horwitz, Paul Tornetta

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

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.

Original languageEnglish
Pages (from-to)E1311-E1318
JournalJournal of the American Academy of Orthopaedic Surgeons
Volume30
Issue number20
DOIs
StatePublished - Oct 15 2022

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