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Risk Factors of Infection After ORIF of Bicondylar Tibial Plateau Fractures

Morris, Brent J. MD*; Unger, R. Zackary BS; Archer, Kristin R. PhD*; Mathis, Shannon L. PhD*; Perdue, Aaron M. MD*; Obremskey, William T. MD, MPH*

doi: 10.1097/BOT.0b013e318284704e
Original Article

Objectives: 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.

Design: We retrospectively identified all bicondylar (AO/OTA 41-C) tibial plateau fractures treated operatively over an 8-year period from 2002 to 2010.

Setting: Single, high-volume, level 1 trauma center.

Patients/Participants: 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.

Intervention: Open reduction internal fixation of bicondylar (AO/OTA 41-C) tibial plateau fractures.

Main Outcome Measurements: 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.

Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

*Division of Orthopaedic Trauma, Vanderbilt Department of Orthopaedic Surgery, Nashville, TN; and

University of Kentucky College of Medicine, Lexington, KY.

Reprints: Brent J. Morris, MD, 1211 Medical Center Dr, Nashville, TN 37232 (e-mail:

Presented at the Orthopaedic Trauma Association Annual Meeting 2011, October 12–15, San Antonio, TX.

The authors report no conflict of interest.

Accepted December 21, 2012

© 2013 by Lippincott Williams & Wilkins