title: Prolonged operative time increases infection rate in tibial plateau fractures.
abstract: BACKGROUND
  Fractures of the tibial plateau present a treatment challenge and are susceptible to both prolonged operative times and high postoperative infection rates. For those fractures treated with open plating, we sought to identify the relationship between surgical site infection and prolonged operative time as well as to identify other surgical risk factors.
  
  
  METHODS
  We performed a retrospective controlled analysis of 309 consecutive unicondylar and bicondylar tibial plateau fractures treated with open plate osteosynthesis at our institution's level I trauma centre during a recent 5-year period. We recorded operative times, injury characteristics, surgical treatment, and need for operative debridement due to infection. Operative times of infected cases were compared to uncomplicated surgical cases. Multivariable logistic regression analysis was performed to identify independent risk factors for postoperative infection.
  
  
  RESULTS
  Mean operative time in the infection group was 2.8h vs. 2.2h in the non-infected group (p=0.005). 15 fractures (4.9%) underwent four compartment fasciotomies as part of their treatment, with a significantly higher infection rate than those not undergoing fasciotomy (26.7% vs. 6.8%, p=0.01). Open fracture grade was also significantly related to infection rate (closed fractures: 5.3%, grade 1: 14.3%, grade 2: 40%, grade 3: 50%, p<0.0001). In the bicolumnar fracture group, use of dual-incision medial and lateral plating as compared to single incision lateral locked plating had statistically similar infection rates (13.9% vs. 8.7%, p=0.36). Multivariable logistic regression analysis of the entire study group identified longer operative times (OR 1.78, p=0.013) and open fractures (OR 7.02, p<0.001) as independent predictors of surgical site infection.
  
  
  CONCLUSIONS
  Operative times approaching 3h and open fractures are related to an increased overall risk for surgical site infection after open plating of the tibial plateau. Dual incision approaches with bicolumnar plating do not appear to expose the patient to increased risk compared to single incision approaches.
authors.affiliation: The University of Pittsburgh Department of Orthopedic Surgery, Division of Traumatology, 3471 Fifth Avenue, Pittsburgh, PA 15213, United States. colmanmw@upmc.edu
authors.forename: Matthew
authors.initials: M
authors.lastname: Colman
authors.forename: Adam
authors.initials: A
authors.lastname: Wright
authors.forename: Gary
authors.initials: G
authors.lastname: Gruen
authors.forename: Peter
authors.initials: P
authors.lastname: Siska
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Pape
authors.forename: Ivan
authors.initials: I
authors.lastname: Tarkin
mesh_terms: D001860:Bone Plates / Q000382:microbiology; D003646:Debridement; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D005597:Fractures, Open / Q000150:complications / Q000382:microbiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D061646:Operative Time; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control*; D013978:Tibial Fractures / Q000150:complications / Q000382:microbiology / Q000601:surgery*; D016896:Treatment Outcome