DeKeyser Graham, Bunzel Eli, O'Neill Dillon, Nork Sean, Haller Justin, Barei David
Department of Orthopaedic Surgery, Oregon Health & Sciences University, Portland, OR.
Harborview Medical Center, University of Washington Department of Orthopaedic Surgery, Seattle, WA; and.
J Orthop Trauma. 2023 Oct 1;37(10):519-524. doi: 10.1097/BOT.0000000000002644.
Comparison of surgical site infection (SSI) rates in tibial plateau fractures with acute compartment syndrome treated with single-incision (SI) versus dual-incision (DI) fasciotomies.
Retrospective cohort study.
Two, Level-1, academic, trauma centers.
Between January 2001 and December 2021, one-hundred ninety patients with a diagnosis of tibial plateau fracture and acute compartment syndrome met inclusion criteria (SI: n = 127, DI: n = 63) with a minimum of 3-month follow-up after definitive fixation.
Emergent 4-compartment fasciotomy, using either SI or DI technique, and eventual plate and screw fixation of the tibial plateau.
The primary outcome was SSI requiring surgical debridement. Secondary outcomes included nonunion, days to closure, method of skin closure, and time to SSI.
Both groups were similar in demographic variables and fracture characteristics (all P > 0.05). The overall infection rate was 25.8% (49 of 190), but the SI fasciotomy patients had significantly fewer SSIs compared with the DI fasciotomy patients [SI 18.1% vs. DI 41.3%; P < 0.001; OR 2.28, (confidence interval, 1.42-3.66)]. Patients with a dual (medial and lateral) surgical approach and DI fasciotomies developed an SSI in 60% (15 of 25) of cases compared with 21.3% (13 of 61) of cases in the SI group ( P < 0.001). The nonunion rate was similar between the 2 groups (SI 8.3% vs. DI 10.3%; P = 0.78). The SI fasciotomy group required fewer debridement's ( P = 0.04) until closure, but there was no difference in days until closure (SI 5.5 vs. DI 6.6; P = 0.09). There were zero cases of incomplete compartment release requiring return to the operating room.
Patients with DI fasciotomies were more than twice as likely to develop an SSI compared with SI patients despite similar fracture and demographic characteristics between the groups. Orthopaedic surgeons should consider prioritizing SI fasciotomies in this setting.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
比较采用单切口（SI）与双切口（DI）筋膜切开术治疗伴有急性骨筋膜室综合征的胫骨平台骨折时手术部位感染（SSI）的发生率。
回顾性队列研究。
两家一级学术创伤中心。
2001年1月至2021年12月期间，190例诊断为胫骨平台骨折并伴有急性骨筋膜室综合征的患者符合纳入标准（SI组：n = 127，DI组：n = 63），在最终固定后至少随访3个月。
采用SI或DI技术进行紧急四室筋膜切开术，并最终对胫骨平台进行钢板螺钉固定。
主要结局为需要手术清创的SSI。次要结局包括骨不连、伤口闭合天数、皮肤闭合方法以及发生SSI的时间。
两组在人口统计学变量和骨折特征方面相似（所有P>0.05）。总体感染率为25.8%（190例中的49例），但与DI筋膜切开术患者相比，SI筋膜切开术患者的SSI明显更少[SI组为18.1%，DI组为41.3%；P<0.001；OR为2.28，（置信区间为1.42 - 3.66）]。采用双侧（内侧和外侧）手术入路及DI筋膜切开术的患者中，60%（25例中的15例）发生了SSI，而SI组这一比例为21.3%（61例中的13例）（P<0.001）。两组的骨不连发生率相似（SI组为8.3%，DI组为10.3%；P = 0.78）。SI筋膜切开术组在伤口闭合前所需的清创次数更少（P = 0.
