• Andrew G Dubina, George Morcos, Nathan N O'Hara, Givenchy W Manzano, Heather A Vallier, Hassan Farooq, Roman M Natoli, Donald Adams, William T Obremskey, Brandon G Wilkinson, Matthew Hogue, Justin M Haller, Lucas S Marchand, Gavin Hautala, Paul E Matuszewski, Guillermo R Pechero, Joshua L Gary, Christopher J Doro, Paul S Whiting, Michael J Chen, Malcolm R DeBaun, Michael J Gardner, Alan W Reynolds, Gregory T Altman, Mitchel R Obey, Anna N Miller, Douglas Haase, Brent Wise, Austin Wallace, Jennifer Hagen, Jeffrey O'Donnell, Mark Gage, Nicholas R Johnson, Madhav Karunakar, Joseph Dynako, John Morellato, Zachary A Panton, I Leah Gitajn, Lucas Haase, George Ochenjele, Erika Roddy, Saam Morshed, Abigail E Sagona, Tyler D Caton, Michael J Weaver, Jerald R Westberg, Jose San Miguel, and Robert V O'Toole.
• Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA.
• Injury. 2022 Nov 1; 53 (11): 3814-3819.

BackgroundTibial plateau fractures with an ipsilateral compartment syndrome are a clinical challenge with limited guidance regarding the best time to perform open reduction and internal fixation (ORIF) relative to fasciotomy wound closure. This study aimed to determine if the risk of fracture-related infection (FRI) differs based on the timing of tibial plateau ORIF relative to closure of ipsilateral fasciotomy wounds.MethodsA retrospective cohort study identified patients with tibial plateau fractures and an ipsilateral compartment syndrome treated with 4-compartment fasciotomy at 22 US trauma centers from 2009 to 2019. The primary outcome measure was FRI requiring operative debridement after ORIF. The ORIF timing relative to fasciotomy closure was categorized as ORIF before, at the same time as, or after fasciotomy closure. Bayesian hierarchical regression models with a neutral prior were used to determine the association between timing of ORIF and infection. The posterior probability of treatment benefit for ORIF was also determined for the three timings of ORIF relative to fasciotomy closure.ResultsOf the 729 patients who underwent ORIF of their tibial plateau fracture, 143 (19.6%) subsequently developed a FRI requiring operative treatment. Patients sustaining infections were: 21.0% of those with ORIF before (43 of 205), 15.9% at the same time as (37 of 232), and 21.6% after fasciotomy wound closure (63 of 292). ORIF at the same time as fasciotomy closure demonstrated a 91% probability of being superior to before closure (RR, 0.75; 95% CrI, 0.38 to 1.10). ORIF after fasciotomy closure had a lower likelihood (45%) of a superior outcome than before closure (RR, 1.02; 95% CrI; 0.64 to 1.39).ConclusionData from this multicenter cohort confirms previous reports of a high FRI risk in patients with a tibial plateau fracture and ipsilateral compartment syndrome. Our results suggest that ORIF at the time of fasciotomy closure has the highest probability of treatment benefit, but that infection was common with all three timings of ORIF in this difficult clinical situation.Copyright © 2022. Published by Elsevier Ltd.

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