title: Surgical site infection in high-energy peri-articular tibia fractures with intra-wound vancomycin powder: a retrospective pilot study.
abstract: BACKGROUND
  Surgical site infections (SSI) continue to be a significant source of morbidity despite the introduction of perioperative intravenous antibiotics. Our objective was to assess the efficacy of local vancomycin powder on lowering deep SSI rates in high-energy tibial plateau and pilon fractures.
  
  
  METHODS
  A retrospective review of all tibial plateau and pilon fractures treated in 2012 at our level I trauma center identified 222 patients. Of these, 107 patients sustained high-energy injuries that required staged fixation, and 93 had minimum 6 month follow-up. Ten patients received 1 gram vancomycin powder directly into the surgical wound at the time of definitive fixation, and the remaining 83 patients served as controls. SSI was defined according to criteria from the Centers for Disease Control. Demographic data, patient comorbidities, injury and treatment details, and infection details were recorded. Descriptive and comparative statistics were performed.
  
  
  RESULTS
  Amongst the vancomycin powder group, 1 patient (10 %) developed a deep SSI; in the control group, 14 (16.7 %) developed deep SSI. The rate of deep SSI between the groups was not statistically significantly different (P = 1.0). The groups were statistically similar with regard to injuries, treatment, comorbidities, and infectious outcomes (P values range = 0.06-1.0).
  
  
  CONCLUSIONS
  The application of local vancomycin powder into surgical wounds of high-energy tibial plateau and pilon fractures did not reduce the rate of deep SSI in this retrospective review. There is a need to find effective, cheap, and widely available methods for prevention of SSI. Basic science and larger prospective clinical studies are needed to further delineate the role of local vancomycin powder as a modality to reduce deep SSI in extremity trauma.
authors.affiliation: Division of Orthopaedic Trauma, Vanderbilt Orthopaedic Institute, Suite 4200 MCE, South Tower, Nashville, TN, 37232, USA.
authors.forename: Keerat
authors.initials: K
authors.lastname: Singh
authors.affiliation: Division of Orthopaedic Trauma, Vanderbilt Orthopaedic Institute, Suite 4200 MCE, South Tower, Nashville, TN, 37232, USA.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Bauer
authors.affiliation: Division of Orthopaedic Trauma, Vanderbilt Orthopaedic Institute, Suite 4200 MCE, South Tower, Nashville, TN, 37232, USA.
authors.forename: Gregory Y
authors.initials: GY
authors.lastname: LaChaud
authors.affiliation: Division of Orthopaedic Trauma, Vanderbilt Orthopaedic Institute, Suite 4200 MCE, South Tower, Nashville, TN, 37232, USA.
authors.forename: Jesse E
authors.initials: JE
authors.lastname: Bible
authors.affiliation: Division of Orthopaedic Trauma, Vanderbilt Orthopaedic Institute, Suite 4200 MCE, South Tower, Nashville, TN, 37232, USA. hassan.mir@vanderbilt.edu.
authors.forename: Hassan R
authors.initials: HR
authors.lastname: Mir
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016022:Case-Control Studies; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011208:Powders; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013978:Tibial Fractures / Q000601:surgery*; D014193:Trauma Centers; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D011208:Powders; D014640:Vancomycin
keywords: Infection; Pilon; Tibial plafond; Tibial plateau; Vancomycin powder