@article{a79be48bcee14b029dff0dc326660e78,
title = "Do superficial infections increase the risk of deep infections in tibial plateau and plafond fractures?",
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.",
keywords = "Deep, Superficial, Surgical site infection, Tibial plafond, Tibial plateau, Vancomycin powder",
author = "METRC and Patterson, {Joseph T.} and O{\textquoteright}Hara, {Nathan N.} and Scharfstein, {Daniel O.} and Castillo, {Renan C.} and O{\textquoteright}Toole, {Robert V.} and Reza Firoozabadi and McAndrew, {Christopher M.} and Gardner, {Michael J.} and Miller, {Anna N.} and Amanda Spraggs-Hughes and Osborn, {Patrick M.} and Rivera, {Jessica C.} and Murray, {Clinton K.} and Kimmel, {Joseph E.} and Bosse, {Michael J.} and Hsu, {Joseph R.} and Karunakar, {Madhav A.} and Seymour, {Rachel B.} and Sims, {Stephen H.} and Christine Churchill and Reilly, {Rachel M.} and Zura, {Robert D.} and Cameron Howes and Weaver, {Michael J.} and Wagstrom, {Emily A.} and Westberg, {Jerald R.} and McKinley, {Todd O.} and Gaski, {Greg E.} and Kempton, {Laurence B.} and Natoli, {Roman M.} and Sorkin, {Anthony T.} and Virkus, {Walter W.} and Lauren Hill and Hymes, {Robert A.} and Malekzadeh, {A. Stephen} and Schulman, {Jeff E.} and Lolita Ramsey and Cuff, {Jaslynn A.N.} and Sharon Haaser and Lee, {Olivia C.} and Krause, {Peter C.} and Rowe, {Cara J.} and Morandi, {Massimo “Max”} and Gary, {Joshua L.} and Boutte, {Sterling J.} and Vallier, {Heather A.} and Breslin, {Mary A.} and Frisch, {H. Michel} and Kaufman, {Adam M.} and Large, {Thomas M.} and LeCroy, {C. Michael} and Smith, {C. D.R.Christopher S.} and Crickard, {Colin V.} and Ly, {Thuan V.} and Elizabeth Sheridan and Jones, {Clifford B.} and Sietsema, {Debra L.} and Reid, {J. Spence} and Andrea Horne and LeBrun, {Christopher T.} and Nascone, {Jason W.} and Sciadini, {Marcus F.} and Gerard Slobogean and Yasmin Degani and Howe, {Andrea L.} and Joshua Rudnicki and Hayda, {Roman A.} and Evans, {Andrew R.} and Bishop, {Julius A.} and Stawicki, {Stanislaw P.} and Nwachuku, {Chinenye O.} and Wojda, {Thomas R.} and Mir, {Hassan R.} and Saqib Rehman and Donnelly, {Joanne M.} and Cyrus Caroom and Mark Jenkins and Bergin, {Patrick F.} and Eldrin Bhanat and Spitler, {Clay A.} and David Teague and William Ertl and Moloney, {Gele B.} and Weinlein, {John C.} and Zelle, {Boris A.} and Animesh Agarwal and Karia, {Ravi A.} and Sathy, {Ashoke K.} and Maroto, {Medardo R.} and Drew Sanders and Higgins, {Thomas F.} and Haller, {Justin M.} and Marchand, {Lucas S.} and Rothberg, {David L.} and Weiss, {David B.} and Yarboro, {Seth R.} and McVey, {Eric D.} and Lang, {Gerald J.} and Whiting, {Paul S.} and Siy, {Alexander B.} and Obremskey, {William T.} and Basem Attum and Boyce, {Robert H.} and Burgos, {Eduardo J.} and Alex Jahangir and Andres Rodriguez-Buitrago and Sethi, {Manish K.} and Trochez, {Karen M.} and Carroll, {Eben A.} and Goodman, {James Brett} and Holden, {Martha B.} and Carlini, {Anthony R.} and Susan Collins and Yanjie Huang and Taylor, {Tara J.} and Mary Zadnik",
note = "Publisher Copyright: {\textcopyright} 2022, The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.",
year = "2023",
month = oct,
doi = "10.1007/s00590-022-03438-1",
language = "English",
volume = "33",
pages = "2805--2811",
journal = "European Journal of Orthopaedic Surgery and Traumatology",
issn = "1633-8065",
number = "7",
}