Session XI - Tibia

Sat., 10/7/06 Tibia, Paper #59, 10:45 am

The Effect of Timing of Definitive Fixation for Tibial Plateau Fractures with Associated Compartment Syndrome on Infection Rates

Robert D. Zura, MD (a-Synthes); Vani Sabesan, MD (*);
Lois Ann Nichols, MD (*); Barnaby Dedmond, MD (*); Patrick Leach, MD (*); Kyle Jeray, MD (*); William Obremskey, MD (*); Brian Mata (*);
Ricardo Pietrobon, MD, PhD, MBA (*); Steven A. Olson, MD for the Southeastern Fracture Consortium (*);
Duke University Medical Center, Division of Orthopaedic Surgery, Durham, North Carolina, USA

Purpose: Tibial plateau fractures with associated compartment syndrome are severe injuries with elevated infection rates. The association between infection and definitive fixation at the time of fasciotomy or definitive fixation at or after the time of fasciotomy closure/coverage is unknown.

Methods: A retrospective study was undertaken at six trauma centers. 87 cases of tibial plateau fractures with associated compartment syndrome were identified. The incidence of superficial and deep infection, the timing of definitive fixation, and the timing of fasciotomy closure or coverage were recorded. Confounding variables including open fractures, concomitant injuries, fixation method, spanning external fixation, use of bone graft, manner of fasciotomy closure/coverage, and time to fasciotomy closure/coverage were examined.

Results: 33 patients underwent definitive fixation prior to fasciotomy coverage/closure. Seven patients (21.2%) developed an infection. 53 patients underwent fixation at the time of or after fasciotomy closure/coverage. Eight patients (15.1%) developed an infection. None of the evaluated factors was demonstrated to significantly confound the association between time of fixation and infection rate. Delayed fixation was 1.4 times more likely to lead to infection than their immediate fixation counterpart, but this association was not considered significant (95% CI 0.6, 3.5, P = 0.4672)

Conclusion/Significance: The timing of definitive internal fixation of tibial plateau fractures with associated compartment syndrome in relationship to fasciotomy closure or coverage does not appear to have an impact on the ultimate rate of infection. Early, definitive fixation may be a viable option in the treatment of these complex injuries.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
· The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an "off label" use). · · FDA information not available at time of printing.