Orthopedics Department, Knee Unit, Hospital del Trabajador ACHS, Ramón Carnicer 185, Providencia, Santiago, Chile.
Orthopedics and Traumatology Resident, Universidad Andrés Bello, Santiago, Chile.
Eur J Orthop Surg Traumatol. 2024 May;34(4):1831-1838. doi: 10.1007/s00590-024-03856-3. Epub 2024 Mar 1.
The reported incidence of infection related with tibial plateau fractures (IRTPF) ranges from 2 to 23%. This complication can result in catastrophic consequences such as deformity, post-traumatic osteoarthritis, chronic pain, loss of function, and substantial economic burdens on healthcare systems due to extended hospital stays and the resources required for treatment. Consequently, it is imperative to emphasize the identification of infection risk factors.
A retrospective case-control study was designed, encompassing patients who underwent surgery for tibial plateau fractures between 2015 and 2020. Frequencies and measures of central tendency were compared between infected patients (cases) and non-infected patients (controls) using rank-based statistical tests. Subsequently, two logistic regression models were employed to control for potential confounding variables.
A total of 314 patients were included, predominantly male (71.15%). Average age of 44.41 years. IRTPF were observed in 7.64% of the patients. In the univariate inferential statistical analysis, high-energy fractures (OR 6.35, p < 0.001), fractures with compartment syndrome (OR 7.10, p < 0.001), two-stage management with temporary external fixation (OR 8.18, p < 0.001), the use of 2 or more approaches in definitive surgery (OR 2.93, p = 0.011), and the use of two or more plates (OR 9.17, p < 0.001) were identified as risk factors for infection. On average, the duration of surgery in infected patients was 201.2 min, compared to 148.4 min in non-infected patients (p < 0.001). When performing two logistic regression models, the following independent risk factors were identified: high-energy fractures (OR 5.04, p = 0.012), the presence of compartment syndrome (OR 4.53, p = 0.007), and the use of two or more plates in definitive surgery (OR 5.04, p = 0.023).
High-energy tibial plateau fractures (Schatzker IV, V, and VI), the presence of concomitant compartment syndrome, and the use of 2 or more plates in definitive surgery are associated with a higher risk of infection related to fracture following open reduction and osteosynthesis treatment.
Case-Control Study.
胫骨平台骨折（IRTPF）相关感染的报告发病率为 2%至 23%。这种并发症可能导致灾难性后果，如畸形、创伤后骨关节炎、慢性疼痛、功能丧失，以及由于延长住院时间和治疗所需资源而给医疗系统带来巨大的经济负担。因此，强调识别感染的危险因素至关重要。
设计了一项回顾性病例对照研究，纳入了 2015 年至 2020 年期间接受胫骨平台骨折手术的患者。使用基于秩的统计检验比较感染患者（病例）和非感染患者（对照）的频率和中心趋势度量。随后，使用两个逻辑回归模型来控制潜在的混杂变量。
共纳入 314 名患者，主要为男性（71.15%）。平均年龄为 44.41 岁。IRTPF 在 7.64%的患者中观察到。在单变量推断性统计分析中，高能骨折（OR 6.35，p<0.001）、伴有间隔综合征的骨折（OR 7.10，p<0.001）、采用临时外固定的两阶段管理（OR 8.18，p<0.001）、确定性手术中使用 2 种或更多入路（OR 2.93，p=0.011）和使用 2 块或更多钢板（OR 9.17，p<0.001）被确定为感染的危险因素。感染患者的手术平均时间为 201.2 分钟，而非感染患者为 148.4 分钟（p<0.001）。在进行两个逻辑回归模型时，确定了以下独立危险因素：高能骨折（OR 5.04，p=0.012）、伴有间隔综合征（OR 4.53，p=0.007）和确定性手术中使用 2 块或更多钢板（OR 5.04，p=0.023）。
高能胫骨平台骨折（Schatzker IV、V 和 VI）、合并间隔综合征和确定性手术中使用 2 块或更多钢板与开放性复位和骨内固定治疗后骨折相关感染的风险增加相关。
病例对照研究。
