Management of surgical site infection post-open reduction and internal fixation for tibial plateau fractures

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Abstract

Aims

In contrast to operations performed for other fractures, there is a high incidence rate of surgical site infection (SSI) post-open reduction and internal fixation (ORIF) done for tibial plateau fractures (TPFs). This study investigates the effect of induced membrane technique combined with internal fixation for managing SSI in TPF patients who underwent ORIF.

Methods

From April 2013 to May 2017, 46 consecutive patients with SSI post-ORIF for TPFs were managed in our centre with an induced membrane technique. Of these, 35 patients were included for this study, with data analyzed in a retrospective manner.

Results

All participants were monitored for a mean of 36 months (24 to 62). None were subjected to amputations. A total of 21 patients underwent two-stage surgeries (Group A), with 14 patients who did not receive second-stage surgery (Group B). Group A did not experience infection recurrence, and no implant or cement spacer loosening was noted in Group B for at least 24 months of follow-up. No significant difference was noted in the Lower Extremity Functional Scale (LEFS) and the Hospital for Special Surgery Knee Score (HSS) between the two groups. The clinical healing time was significantly shorter in Group B (p＜0.001). Those with longer duration of infection had poorer functional status (p＜0.001).

Conclusion

Management of SSI post-ORIF for TPF with induced membrane technique combined with internal fixation represents a feasible mode of treatment with satisfactory outcomes in terms of infection control and functional recovery.

Cite this article: Bone Joint Res 2021;10(7):380–387.

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Most cited references 45

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Over the last 15 years, with the advent of modern standards in the control of sterility within the operating room environment and adequate protocols of peri-operative antibiotic prophylaxis, the incidence of infections associated to orthopedic implants has become very low. Nevertheless, the event of infection still represents one of the most serious and devastating complications which may involve prosthetic devices. It leads to complex revision procedures and, often, to the failure of the implant and the need for its complete removal. In orthopedics, for the enormous number of surgical procedures involving invasive implant materials, even if nowadays rare, infections have a huge impact in terms of morbidity, mortality, and medical costs. The difficult battle to prevent and fight bacterial infections associated to prosthetic materials must be played on different grounds. A winning strategy requires a clear view of the pathogenesis and the epidemiology of implant-related infections, with a special attention on the alarming phenomenon of antibiotic resistance. In this regard staphylococci are the prevalent and most important causative pathogens involved in orthopedic implant-related infections, and, thus, the main enemy to defeat. In this paper, we offer an overview of the complexity of this battleground and of the current and new, in our opinion most promising, strategies in the field of biomaterials to reduce the risks and counteract the establishment of implant infections.

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Author and article information

Contributors

Jie Shen: Role: Orthopaedic Surgeon

Dong Sun: Role: Orthopaedic Surgeon, Associate Professor

Jingshu Fu: Role: Orthopaedic Surgeon

Shulin Wang: Role: Clinical Researcher

Xiaohua Wang: Role: Orthopaedic Surgeon

Zhao Xie: Role: Professor

Journal

Journal ID (nlm-ta): Bone Joint Res

Journal ID (iso-abbrev): Bone Joint Res

Journal ID (publisher-id): bjr

Title: Bone & Joint Research

Publisher: The British Editorial Society of Bone & Joint Surgery (London )

ISSN (Electronic): 2046-3758

Publication date Collection: July 2021

Publication date (Electronic): 05 July 2021

Volume: 10

Issue: 7

Pages: 380-387

Affiliations

[1 ] org-divisionNational & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics , org-divisionSouthwest Hospital, Army Medical University , Chongqing, China

Author notes

Zhao Xie. E-mail: xiezhao54981@ 123456163.com

J. Shen and D. Sun are joint first authors.

Article

Publisher ID: BJR-10-380

DOI: 10.1302/2046-3758.107.BJR-2020-0175.R2

PMC ID: 8333030

PubMed ID: 34218687

SO-VID: 3ab0c8ab-bd21-4770-b898-60f7f506cc3d

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc-nd/4.0/.

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principal-institution Southwest Hospital, Army Medical University, Chongqing, China

article-type Infection

coi-statement All the authors declare that there is no conflict of interest.

Keywords: surgical site infection,tibial plateau fractures,induced membrane technique,internal fixation

Data availability:

Keywords: surgical site infection, tibial plateau fractures, induced membrane technique, internal fixation

Management of surgical site infection post-open reduction and internal fixation for tibial plateau fractures

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Decoding Infection and Transmission

Most cited references 45

Understanding biofilm resistance to antibacterial agents.

The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network.

The significance of infection related to orthopedic devices and issues of antibiotic resistance.

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