Franulic Nicolas, Muñoz Jose Tomas, Pineda Tomas, Laso Jose, Olivieri Rodrigo, Schröter Steffen
Knee Unit, Orthopedic Department, Hospital del Trabajador ACHS, Santiago, Chile.
Knee Unit, Orthopedic Department, Hospital Militar de Santiago, Chile.
EFORT Open Rev. 2024 Dec 2;9(12):1170-1178. doi: 10.1530/EOR-24-0058.
Fracture-related infection (FRI) after tibial plateau open reduction and fixation is a common complication that leads to catastrophic sequelae and substantial economic costs, making prevention paramount. To facilitate an appropriate approach, it is useful to classify risk factors based on patient-related factors, injury-related factors, and management-related factors. Patient-related factors like smoking have a great amount of evidence establishing their relation with FRI. Diabetes and obesity might be associated, but evidence is somewhat conflicting. Nevertheless, smoking cessation and a multidisciplinary approach for these pathologies are essential to prevent FRI. Injury-related factors like high-energy fractures and acute compartment syndrome have compelling evidence relating them to FRI and must be acknowledged as inherent factors. While the exposure of the fracture has been associated with infection, open fractures are yet to be confirmed as directly related to FRI in tibial plateau fractures. Likewise, early antibiotic prophylaxis and surgical debridement are mandatory. As for management-related factors, increased surgical time emerges as a strong predictor for FRI. Evidence regarding the number of surgical approaches and plates shows a trend toward an increase in FRI prevalence. With respect to external fixator installation and removal, pin-plate overlapping is yet to be confirmed or ruled out as risk factors.
胫骨平台切开复位内固定术后的骨折相关感染（FRI）是一种常见并发症，可导致灾难性后果和巨大经济成本，因此预防至关重要。为了采取适当的方法，根据患者相关因素、损伤相关因素和管理相关因素对风险因素进行分类是很有用的。像吸烟这样的患者相关因素有大量证据表明其与FRI有关。糖尿病和肥胖可能有关联，但证据有些相互矛盾。尽管如此，戒烟以及针对这些病症采取多学科方法对于预防FRI至关重要。像高能骨折和急性骨筋膜室综合征这样的损伤相关因素有令人信服的证据表明它们与FRI有关，必须将其视为内在因素。虽然骨折暴露与感染有关，但在胫骨平台骨折中，开放性骨折尚未被证实与FRI直接相关。同样，早期抗生素预防和手术清创是必需的。至于管理相关因素，手术时间延长是FRI的一个强有力预测因素。关于手术入路数量和钢板数量的证据显示FRI患病率有上升趋势。关于外固定器的安装和拆除，针板重叠作为风险因素尚未得到证实或排除。
