title: Timing of definitive fixation of severe tibial plateau fractures with compartment syndrome does not have an effect on the rate of infection.
abstract: BACKGROUND
  Tibial plateau fractures with associated compartment syndrome are severe injuries with elevated infection rates. The objective of this article was to analyze whether there is an association between infection and the timing of definitive fracture fixation in relation to fasciotomy closure or coverage.
  
  
  METHODS
  Eighty-one tibial plateau fractures, complicated by compartment syndrome, were treated with four-compartment fasciotomies and definitive fracture fixation before, at, or after fasciotomy closure or coverage.
  
  
  RESULTS
  Thirty extremities were treated with definitive fixation before fasciotomy closure. Seven (23%) of these extremities developed an infection. Twenty-six extremities were treated with definitive internal fixation at the time of fasciotomy closure of which three (12%) developed an infection. Twenty-five extremities were treated definitively after fasciotomy closure of which four (16%) developed an infection. There was no significant difference in the rate of infection among the groups (p = 0.5012).
  
  
  CONCLUSIONS
  This study demonstrated no statistical difference in the rate of infection when tibial plateau fractures with four-compartment fasciotomies were treated with open reduction and internal fixation before fasciotomy closure, at fasciotomy closure, or after fasciotomy closure. Based on the data presented herein, it seems that definitive fracture treatment can be determined by the condition of patient and by surgeon preference and experience without exposing the patient to the additional risk of infection.
authors.affiliation: Division of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA. zura0001@mc.duke.edu
authors.forename: Robert D
authors.initials: RD
authors.lastname: Zura
authors.forename: Samuel B
authors.initials: SB
authors.lastname: Adams
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Jeray
authors.forename: William T
authors.initials: WT
authors.lastname: Obremskey
authors.forename: Sandra S
authors.initials: SS
authors.lastname: Stinnett
authors.forename: Steven A
authors.initials: SA
authors.lastname: Olson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003161:Compartment Syndromes / Q000150:complications / Q000601:surgery*; D000071938:Fasciotomy; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013530:Surgical Wound Infection / Q000453:epidemiology*; D013978:Tibial Fractures / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome