title: Surgical site infection in tibial plateau fractures with ipsilateral compartment syndrome.
abstract: OBJECTIVE
  The aim of this study was to investigate the effects of compartment syndrome and timing of fasciotomy wound closure on surgical site infection (SSI) after surgical fixation of tibial plateau fractures. Our primary hypothesis was that SSI rate is increased for fractures with compartment syndrome versus those without, even accounting for confounders associated with infection. Our secondary hypothesis was that infection rates are unrelated to timing of fasciotomy closure or fixation.
  
  
  METHODS
  We conducted a retrospective cohort study of operative tibial plateau fractures with ipsilateral compartment syndrome (n=71) treated with fasciotomy at our level I trauma center from 2003 through 2011. A control group consisted of 602 patients with 625 operatively treated tibial plateau fractures without diagnosis of compartment syndrome. The primary outcome measure was deep SSI after ORIF.
  
  
  RESULTS
  Fractures with compartment syndrome had a higher rate of SSI (25% versus 8%, p<0.001). The difference remained significant in our multivariate model (odds ratio, 7.27; 95% confidence interval, 3.8-13.9). Delay in timing of fasciotomy closure was associated with a 7% increase per day in odds of infection (95% confidence interval, 0.2-13; p<0.05).
  
  
  CONCLUSIONS
  Tibial plateau fractures with ipsilateral compartment syndrome have a significant increase in rates of SSI compared with those without compartment syndrome (p<0.001). Delays in fasciotomy wound closure were also associated with increased odds of SSI (p<0.05).
authors.affiliation: R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Dubina
authors.affiliation: R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Ebrahim
authors.initials: E
authors.lastname: Paryavi
authors.affiliation: R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Theodore T
authors.initials: TT
authors.lastname: Manson
authors.affiliation: R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Allmon
authors.affiliation: R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA. Electronic address: rotoole@umoa.umm.edu.
authors.forename: Robert V
authors.initials: RV
authors.lastname: O'Toole
mesh_terms: D003161:Compartment Syndromes / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D000071938:Fasciotomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D005597:Fractures, Open / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000473:pathology / Q000601:surgery*; D013978:Tibial Fractures / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Compartment syndrome; Complication; Surgical site infection; Tibial plateau fracture