title: Risk factors of infection after ORIF of bicondylar tibial plateau fractures.
abstract: OBJECTIVE
  This study was designed to evaluate risk factors of infection after bicondylar tibial plateau fractures. We hypothesized that open fractures and smoking would be associated with deep infection requiring reoperation.
  
  
  METHODS
  We retrospectively identified all bicondylar (AO/OTA 41-C) tibial plateau fractures treated operatively over an 8-year period from 2002 to 2010.
  
  
  METHODS
  Single, high-volume, level 1 trauma center.
  
  
  METHODS
  A total of 302 patients aged 18 years and older were identified as undergoing operative fixation of bicondylar (AO/OTA 41-C) tibial plateau fractures during this time period.
  
  
  METHODS
  Open reduction internal fixation of bicondylar (AO/OTA 41-C) tibial plateau fractures.
  
  
  METHODS
  Bivariate and multivariable logistic regression analyses were used to assess the association between patient demographics and clinical characteristics and deep infection requiring reoperation. Variables that were significant at P < 0.05 in bivariate analyses were entered into a multivariable logistic regression model.
  
  
  RESULTS
  Forty-three (14.2%) of 302 patients developed deep infection requiring reoperation. Methicillin-resistant Staphylococcus aureus (MRSA) was cultured in 20 (46.5%) of 43 patients with deep infections. An external fixator was initially placed before definitive fixation in 81.4% of patients and definitive surgical treatment was delayed by an average of 17.5 days. Eighty-five (28.1%) patients required a reoperation after definitive fixation.Open fracture (OR, 3.44; P = 0.003), smoking (OR, 2.40; P = 0.02), compartment syndrome requiring fasciotomies (OR, 3.81; P = 0.01), and fractures requiring 2 incisions and 2 plates (OR, 3.19; P = 0.01) were all risk factors for deep infection requiring reoperation.
  
  
  CONCLUSIONS
  In spite of a staged protocol with temporizing external fixation and delayed fixation, deep infection rate remained high. A disproportionate amount of MRSA (47%) was cultured from deep infections in this population, and MRSA prophylaxis may be considered. Smoking was the only patient modifiable predictor identified of deep infection, and patients should be informed of the increased risk of deep infection associated with their choice to continue smoking.
  
  
  METHODS
  Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Division of Orthopaedic Trauma, Vanderbilt Department of Orthopaedic Surgery, Nashville, TN, USA. brent.j.morris@vanderbilt.edu
authors.forename: Brent J
authors.initials: BJ
authors.lastname: Morris
authors.forename: R Zackary
authors.initials: RZ
authors.lastname: Unger
authors.forename: Kristin R
authors.initials: KR
authors.lastname: Archer
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Mathis
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Perdue
authors.forename: William T
authors.initials: WT
authors.lastname: Obremskey
mesh_terms: D000328:Adult; D000368:Aged; D003161:Compartment Syndromes / Q000150:complications*; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D005597:Fractures, Open / Q000150:complications*; D006801:Humans; D015994:Incidence; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012044:Regression Analysis; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000382:microbiology; D013978:Tibial Fractures / Q000382:microbiology / Q000601:surgery*