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International Orthopaedics

, Volume 43, Issue 2, pp 461–465 | Cite as

Wound complications after open reduction and internal fixation of tibial plateau fractures in the elderly: a multicentre study

  • Christopher L. Gaunder
  • Zibin Zhao
  • Corey Henderson
  • Brandon R. McKinney
  • Philip F. Stahel
  • Boris A. ZelleEmail author
Original Paper

Abstract

Purpose

The incidence of wound complications after open reduction with internal fixation (ORIF) of tibial plateau fractures in young patients has been reported to range from approximately 5 to 15%. Reports on wound complication rates in the elderly patients are limited. This study investigates the incidence of post-operative wound complications in elderly patients undergoing ORIF of their tibial plateau fractures.

Methods

A retrospective study was performed within three accredited level 1 trauma centres. Patients > 60 years of age undergoing open reduction and internal fixation of their tibial plateau fractures were included. The primary outcome measure was wound complications of the surgical site. These were divided into superficial infections versus deep infections.

Results

One hundred two patients matched the inclusion criteria. Of these, 16 patients (15.7%) developed a post-operative wound infection. The analysis of underlying co-morbidities and risk factors revealed that patients with American Society of Anaesthesiologists (ASA) classes 3 and 4 were at significantly increased risk of sustaining a wound complications as compared to ASA classes 1 and 2 (23.7 versus 5.1%, p = 0.015).

Conclusions

The overall infection rates in elderly patients undergoing ORIF for tibial plateau fractures is in a similar range to published data on younger patient populations. In particular, elderly patients without significant co-morbidities seem to be appropriate candidates for ORIF of their tibial plateau fractures. However, elderly patients with significant co-morbidities must be considered as high risk and alternative treatment options, such as nonoperative treatment or less invasive surgical options, should be explored in these patients.

Keywords

Tibial plateau Fracture Elderly Complication Surgical site infection 

References

  1. 1.
    Honkonen S (1994) Indications for surgical treatment of tibial condyle fractures. Clin Orthop Relat Res 302:199–205Google Scholar
  2. 2.
    Barei D, Nork S, Mills W, Henley M, Benirschke S (2004) Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique. J Orthop Trauma 18:649–657.  https://doi.org/10.1097/00005131-200411000-00001 CrossRefGoogle Scholar
  3. 3.
    Li J, Zhu Y, Liu B, Dong T, Chen W, Zhang Y (2017, 2017) Incidence and risk factors for surgical site infection following open reduction and internal fixation of adult tibial plateau fractures. Int Orthop.  https://doi.org/10.1007/s00264-017-3729-2
  4. 4.
    Shah S, Karunakar M (2007) Early wound complications after operative treatment of high energy tibial plateau fractures through two incisions. Bull Hosp Joint Dis 65:115–119Google Scholar
  5. 5.
    Su E, Westrich G, Rana A, Kapoor K, Helfet D (2004) Operative treatment of tibial plateau fractures in patients older than 55 years. Clin Orthop Relat Res 421:240–248.  https://doi.org/10.1097/01.blo.0000119247.60317.bc CrossRefGoogle Scholar
  6. 6.
    Hsu C, Chang W, Wong C (2001) Surgical treatment of tibial plateau fracture in elderly patients. Arch Orthop Trauma Surg 121:67–70.  https://doi.org/10.1007/s004020000145 CrossRefGoogle Scholar
  7. 7.
    Ali A, Saleh M, Eastell R, Wigderowitz C, Rigby A, Yang L (2006) Influence of bone quality on the strength of internal and external fixation of tibial plateau fractures. J Orthop Res 24:2080–2086.  https://doi.org/10.1002/jor.20270 CrossRefGoogle Scholar
  8. 8.
    Stevens D, Beharry R, Waddell J, Schemitsch E (1999) Long term functional outcome of operatively treated tibial plateau fractures. J Orthop Trauma 13:295–296.  https://doi.org/10.1097/00005131-199905000-00043 CrossRefGoogle Scholar
  9. 9.
    American Society of Anesthesiologists (1963) New classification of physical status. Anesthesiology 24:111Google Scholar
  10. 10.
    Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B, Audigé L (2007) Fracture and dislocation classification compendium - 2007: orthopaedic trauma association classification, database and outcomes committee. J Orthop Trauma 21(10 Suppl):S1–S133Google Scholar
  11. 11.
    Momaya AM, Hlavacek J, Etier B, Johannesmeyer D, Oladeji LO, Niemeier TE, Herrera N, Lowe JA (2016) Risk factors for infection after operative fixation of tibial plateau fractures. Injury 47:1501–1505.  https://doi.org/10.1016/j.injury.2016.04.011 CrossRefGoogle Scholar
  12. 12.
    Morris B, Unger R, Archer K, Mathis S, Perdue A, Obremskey W (2013) Risk factors of infection after ORIF of bicondylar tibial plateau fractures. J Orthop Trauma 27:e196–e200.  https://doi.org/10.1097/bot.0b013e318284704e. CrossRefGoogle Scholar
  13. 13.
    Colman M, Wright A, Gruen G, Siska P, Pape H, Tarkin I (2013) Prolonged operative time increases infection rate in tibial plateau fractures. Injury 44:249–252.  https://doi.org/10.1016/j.injury.2012.10.032 CrossRefGoogle Scholar
  14. 14.
    Hurwitz EE, Simon M, Vinta SR, Zehm CF, Shabot SM, Minhajuddin A, Abouleish AE (2017) Adding examples to the ASA-physical status classification improves correct assignment to patients. Anesthesiology 126:614–622.  https://doi.org/10.1097/aln.0000000000001541 CrossRefGoogle Scholar
  15. 15.
    Ng VY, Lustenberger D, Hoang K, Urchek R, Beal M, Calhoun JH, Glassman AH (2013) Preoperative risk stratification and risk reduction for total joint reconstruction. J Bone Joint Surg Am 95:e191–e115CrossRefGoogle Scholar
  16. 16.
    Lee M (2013) Optimizing the safety of surgery, before surgery. Clin Orthop Relat Res 472:809–811CrossRefGoogle Scholar
  17. 17.
    Guss D, Bhattacharyya T (2006) Perioperative management of the obese orthopaedic patient. J Am Acad Orthop Surg 14:425–432CrossRefGoogle Scholar
  18. 18.
    Canale T, Kelly F, Daugherty K (2012) Smoking threatens orthopaedic outcomes. AAOS Now 6:1Google Scholar
  19. 19.
    Castillo RC, Bosse MJ, MacKenzie EJ, Patterson BM, LEAP Study Group (2005) Impact of smoking on fracture healing and risk of complications in limb-threatening open tibia fractures. J Orthop Trauma 19:151–157CrossRefGoogle Scholar
  20. 20.
    Lin S, Mauffrey C, Hammerberg EM, Stahel PF, Hak DJ (2013) Surgical site infection after open reduction and internal fixation of tibial plateau fractures. Eur J Orthop Surg Traumatol 24:797–803.  https://doi.org/10.1007/s00590-013-1252-8 CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Christopher L. Gaunder
    • 1
  • Zibin Zhao
    • 2
  • Corey Henderson
    • 3
  • Brandon R. McKinney
    • 1
  • Philip F. Stahel
    • 3
  • Boris A. Zelle
    • 2
    Email author
  1. 1.Department of Orthopaedics and RehabilitationSan Antonio Military Medical CenterSan AntonioUSA
  2. 2.Department of Orthopaedic SurgeryUT Health San AntonioSan AntonioUSA
  3. 3.Rocky Vista UniversityParkerUSA

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