Influence of prior fasciotomy on infection after open reduction and internal fixation of tibial plateau fractures

Abstract

Background: High-energy tibial plateau fractures may present with an acute or impending compartment syndrome requiring emergent fasciotomy. There is little information regarding the optimal management of the fasciotomy wound with respect to the subsequent definitive internal fixation of the tibial plateau fracture. The purpose of this study was to compare the rate of infection complication after internal fixation of tibial plateau fractures in patients requiring fasciotomy for compartment syndrome with patients in whom a fasciotomy was not required.

Methods: We retrospectively reviewed all tibial plateau fractures presenting over a 55-month period. Fourteen patients who presented with an associated compartment syndrome requiring fasciotomy and 128 patients in whom a fasciotomy was not performed met inclusion criteria. Patients age, sex, mechanism of injury, management of their fasciotomy, operative treatment of their plateau fracture, follow-up surgical procedures, follow-up complications, and length of follow-up were reviewed. Infection complications were defined as cellulitis requiring treatment with intravenous or oral antibiotics, patients requiring operative debridement after definitive fixation, and documentation of osteomyelitis.

Results: In the fasciotomy group, two patients developed cellulitis that was treated with a short course on oral antibiotics. There were no documented deep infections. In the no fasciotomy group, eight patients (6.25%) had a documented culture-positive deep infection. Additionally, six patients had documented occurrences of cellulitis managed with oral or intravenous antibiotics.

Conclusions: Definitive internal fixation of tibial plateau fractures in the presence of open fasciotomy wounds does not seem to be associated with an increased infection risk.