Factores de riesgo de infección de fracturas de meseta tibial / Risk factors for infection of tibial plateau fractures

Introducción: Las fracturas de meseta tibial (FMT) son lesiones propensas a infecciones postoperatorias, siendo la incidencia descrita superior a la del resto de fracturas, entre un 5 y un 12%. Los objetivos primarios de este estudio fueron cuantificar la tasa de infección postoperatoria de osteosíntesis de FMT e identificar los factores de riesgo de esta. Material y métodos: Estudio de cohorte retrospectiva incluyendo a pacientes intervenidos de osteosíntesis de FMT entre 2015 y 2020, en un mismo centro. La población del estudio se dividió en 2 grupos, según la presencia o no de infección postoperatoria. Se recogieron variables demográficas relacionadas con la fractura, parámetros quirúrgicos, así como necesidad de reintervención. Finalmente, en caso de desbridamiento, se recogieron número de cultivos positivos y patógeno responsable de infección, así como el tratamiento aplicado. Resultados: Se incluyeron un total de 124 pacientes, con un total de 14 infecciones (tasa global de infección de 11,3%). Se identificaron como factores de riesgo para desarrollar infección el hecho de tratarse de fracturas abiertas (p=0,002), fracturas tipo Schatzker V y VI (p=0,002) y el uso de fijador externo (p<0,001). En lo que respecta a las variables quirúrgicas solo se identificó el mayor tiempo de isquemia (p=0,032) como factor de riesgo. S. aureus fue el microorganismo más frecuentemente identificado (43%), seguido de E. cloacae (35,7%). Conclusión: La tasa global de infección tras osteosíntesis de fractura de meseta tibial fue del 11,3%. Diferentes factores se asocian a más riesgo de infección, entre ellos la diabetes mellitus, las fracturas abiertas, el uso de fijador externo, un mayor grado en la clasificación de Schatzker o un mayor tiempo de isquemia intraoperatoria.(AU)

Introduction: Tibial plateau fractures are injuries prone to postoperative infection, with its reported incidence being higher than that of other fractures, between 5% and 12%. The primary objectives of this study were to quantify the postoperative infection rate of internal fixation of tibial plateau fractures (TPF) and to identify the risk factors for this. Material and methods: Retrospective cohort study including patients who underwent TPF osteosynthesis between 2015 and 2020, in the same center. The study population was divided into two groups, according to the presence or absence of postoperative infection. Demographic variables related to the fracture, surgical parameters, as well as the need for reoperation were collected. Finally, in the case of debridement, the number of positive cultures and the pathogen responsible for the infection were collected, as well as the treatment applied. Results: One hundred and twenty-four patients were included, with a total of 14 infections (global infection rate of 11.3%). Risk factors for developing infection were open fractures (P=.002), Schatzker V and VI type fractures (P=.002) and the use of external fixation (P<.001). Regarding the surgical variables, only the longest ischemia time (P=.032) was identified as a risk factor. S. aureus was the most frequently identified microorganism (43%), followed by E. cloacae (35.7%). Conclusion: The overall infection rate after osteosynthesis of tibial plateau fractures was 11.3%. Different factors are associated with a higher risk of infection, including diabetes mellitus, open fractures, the use of external fixation, a higher grade in the Schatzker classification or a longer intraoperative ischemia time.(AU)

[Translated article] Risk factors for infection of tibial plateau fractures / Factores de riesgo de infección de fracturas de meseta tibial

Introducción: Las fracturas de meseta tibial (FMT) son lesiones propensas a infecciones postoperatorias, siendo la incidencia descrita superior a la del resto de fracturas, entre un 5 y un 12%. Los objetivos primarios de este estudio fueron cuantificar la tasa de infección postoperatoria de osteosíntesis de FMT e identificar los factores de riesgo de esta. Material y métodos: Estudio de cohorte retrospectiva incluyendo a pacientes intervenidos de osteosíntesis de FMT entre 2015 y 2020, en un mismo centro. La población del estudio se dividió en 2 grupos, según la presencia o no de infección postoperatoria. Se recogieron variables demográficas relacionadas con la fractura, parámetros quirúrgicos, así como necesidad de reintervención. Finalmente, en caso de desbridamiento, se recogieron número de cultivos positivos y patógeno responsable de infección, así como el tratamiento aplicado. Resultados: Se incluyeron un total de 124 pacientes, con un total de 14 infecciones (tasa global de infección de 11,3%). Se identificaron como factores de riesgo para desarrollar infección el hecho de tratarse de fracturas abiertas (p=0,002), fracturas tipo Schatzker V y VI (p=0,002) y el uso de fijador externo (p<0,001). En lo que respecta a las variables quirúrgicas solo se identificó el mayor tiempo de isquemia (p=0,032) como factor de riesgo. S. aureus fue el microorganismo más frecuentemente identificado (43%), seguido de E. cloacae (35,7%). Conclusión: La tasa global de infección tras osteosíntesis de fractura de meseta tibial fue del 11,3%. Diferentes factores se asocian a más riesgo de infección, entre ellos la diabetes mellitus, las fracturas abiertas, el uso de fijador externo, un mayor grado en la clasificación de Schatzker o un mayor tiempo de isquemia intraoperatoria.(AU)

Introduction: Tibial plateau fractures are injuries prone to postoperative infection, with its reported incidence being higher than that of other fractures, between 5% and 12%. The primary objectives of this study were to quantify the postoperative infection rate of internal fixation of tibial plateau fractures (TPF) and to identify the risk factors for this. Material and methods: Retrospective cohort study including patients who underwent TPF osteosynthesis between 2015 and 2020, in the same center. The study population was divided into two groups, according to the presence or absence of postoperative infection. Demographic variables related to the fracture, surgical parameters, as well as the need for reoperation were collected. Finally, in the case of debridement, the number of positive cultures and the pathogen responsible for the infection were collected, as well as the treatment applied. Results: One hundred and twenty-four patients were included, with a total of 14 infections (global infection rate of 11.3%). Risk factors for developing infection were open fractures (P=.002), Schatzker V and VI type fractures (P=.002) and the use of external fixation (P<.001). Regarding the surgical variables, only the longest ischemia time (P=.032) was identified as a risk factor. S. aureus was the most frequently identified microorganism (43%), followed by E. cloacae (35.7%). Conclusion: The overall infection rate after osteosynthesis of tibial plateau fractures was 11.3%. Different factors are associated with a higher risk of infection, including diabetes mellitus, open fractures, the use of external fixation, a higher grade in the Schatzker classification or a longer intraoperative ischemia time.(AU)

Risk factors for infection of tibial plateau fractures. / Factores de riesgo de infección de fracturas de meseta tibial.

INTRODUCTION: Tibial plateau fractures are injuries prone to postoperative infection, with its reported incidence being higher than that of other fractures, between 5% and 12%. The primary objectives of this study were to quantify the postoperative infection rate of internal fixation of tibial plateau fractures (TPF) and to identify the risk factors for this. MATERIAL AND METHODS: Retrospective cohort study including patients who underwent TPF osteosynthesis between 2015 and 2020, in the same center. The study population was divided into two groups, according to the presence or absence of postoperative infection. Demographic variables related to the fracture, surgical parameters, as well as the need for reoperation were collected. Finally, in the case of debridement, the number of positive cultures and the pathogen responsible for the infection were collected, as well as the treatment applied. RESULTS: One hundred and twenty-four patients were included, with a total of 14 infections (global infection rate of 11.3%). Risk factors for developing infection were open fractures (P=.002), Schatzker V and VI type fractures (P=.002) and the use of external fixation (P<.001). Regarding the surgical variables, only the longest ischemia time (P=.032) was identified as a risk factor. S. aureus was the most frequently identified microorganism (43%), followed by E. cloacae (35.7%). CONCLUSION: The overall infection rate after osteosynthesis of tibial plateau fractures was 11.3%. Different factors are associated with a higher risk of infection, including diabetes mellitus, open fractures, the use of external fixation, a higher grade in the Schatzker classification or a longer intraoperative ischemia time.

[Translated article] Risk factors for infection of tibial plateau fractures.

INTRODUCTION: Tibial plateau fractures are injuries prone to postoperative infection, with its reported incidence being higher than that of other fractures, between 5% and 12%. The primary objectives of this study were to quantify the postoperative infection rate of internal fixation of tibial plateau fractures (TPFs) and to identify the risk factors for this. MATERIAL AND METHODS: Retrospective cohort study including patients who underwent TPF osteosynthesis between 2015 and 2020, in the same center. The study population was divided into two groups, according to the presence or absence of postoperative infection. Demographic variables related to the fracture, surgical parameters, as well as the need for reoperation were collected. Finally, in the case of debridement, the number of positive cultures and the pathogen responsible for the infection were collected, as well as the treatment applied. RESULTS: One hundred and twenty-four patients were included, with a total of 14 infections (global infection rate of 11.3%). Risk factors for developing infection were open fractures (p=.002), Schatzker V and VI type fractures (p=.002) and the use of external fixation (p<.001). Regarding the surgical variables, only the longest ischemia time (p=.032) was identified as a risk factor. Staphylococcus aureus was the most frequently identified microorganism (43%), followed by Enterobacter cloacae (35.7%). CONCLUSION: The overall infection rate after osteosynthesis of tibial plateau fractures was 11.3%. Different factors are associated with a higher risk of infection, including diabetes mellitus, open fractures, the use of external fixation, a higher grade in the Schatzker classification or a longer intraoperative ischemia time.

Abordaje posterior en fracturas de meseta tibial complejas en pacientes tratados quirúrgicamente en el IAHULA / Posterior approach in complex tibial plateau fractures IAHUL A Surgically treated patients

Las fracturas de meseta tibial compleja se asocian a traumatismo de alta energía, principalmente en accidentes de motocicleta, siendo un desafío para el cirujano ortopedista. En la década de 1970, Schatzker propuso una clasificación radiológica para las fracturas de la meseta tibial, que destacaba la morfología de los seis tipos principales. Las imágenes de tomografía computarizada y tridimensional, han cambiado la comprensión y el tratamiento de las fracturas de la meseta tibial. Recientemente, esa clasificación original se complementó con una más amplia; puesto que, se introdujo el fragmento en cuña dividida y la continuidad de la columna posterior como determinantes de la estabilidad articular y el papel fundamental que desempeña en el tratamiento de las fracturas de la meseta tibial, con ellos también la importancia de abordajes quirúrgicos que permitan la visualización posterior para una adecuada reducción. El estudio documenta las técnicas de fijación interna y abordajes posteriores realizadas en el IAHULA, valorando los resultados clínicos en cuanto a dolor y satisfacción del paciente, como consolidación, pseudoartrosis o falla en la técnica de osteosíntesis realizada. El resultado a partir de las escalas de evaluación de la AO y KOOS, arrojaron que, con un efecto excelentes se agrupa un 28,6% y bueno a un 42,9%, indicando la importancia de la fijación de la columna posterior, para prevenir artrosis postraumática temprana e inestabilidad articular(AU)

A complex fracture of the posterior tibial plateau are related to high energy traumatisms, mainly during motorcycle accidents, becoming a challenge to the ortopedic surgen. During the seventies, Stchatzker proposed a radiologic classification for the tibial plateau fractures that pointed the morphology of six main types. The computarized and tridimensional tomographic images have changed the comprehension and treatment of these fractures. Recently, the original classification was complemented with a more broaded approach due to the introduction of the fragment in divided crib and the continuity of the posterior column as factors determining the articular stability and the fundamental roll played in the treatment of fractures of the tibial plateau, as well as the important roll of surgical approaches that allow the posterior visualization for a correct reduction. This research documents the technics of internal fixation and posterior approach developed in the IAHULA, evaluating the clinic results about patients' pain level and comfort, as well as the radiologic findings of consolidation, pseudoarthrosis, or fail in the technic of osteosynthesis developed. The results from a point of view of the evaluation scales of the AO and KOOS, show 28.6% with excellent outcomes, and 42.9% with good outcomes, indicating the importance of the fixation of the posterior column to prevent early start of posttraumatic arthrosis and articular instability(AU)

Abordaje posteromedial y colocación de placa en fractura de meseta tibial con fragmento posterior / Posteromedial approach and plating for a tibial plateau fracture with a posterior fragment

Antecedentes: Las fracturas de meseta tibial representan 1% de todas las fracturas, de éste, 10% corresponde a la meseta medial. El espectro de lesiones va desde fracturas no desplazadas hasta fracturas devastadoras del platillo tibial completo que requieren manejo quirúrgico extenso. Literatura en cirugía ortopédica sugiere que los resultados funcionales y radiográficos positivos dependen del tipo de abordaje, la calidad de la reducción y el tipo de implante utilizado. Material y métodos: Reporte de casos ambispectivo; comprendió de siete pacientes con fractura de meseta tibial medial y fragmento posterior a los cuales se les colocó placa posterior luego del abordaje posteromedial en un período de tiempo entre Agosto 2012 y Agosto 2013. Se utilizó la clasificación de Khan para estadificar la fractura. Se evaluó el resultado funcional y radiográfico mediante escala de Rasmussen. Se realizó estadística de frecuencias y descriptiva. Resultados: Se midió el dolor utilizando la escala visual análoga (EVA), encontrando un mínimo de dos puntos y un máximo de cuatro puntos. La flexión osciló entre 40º y 110º con un déficit de extensión mínimo de 15º y máximo de 40º. La deformidad en varo se presentó en cuatro sujetos, la deformidad en valgo en tres. Conclusiones: El abordaje posteromedial y la colocación de placa posterior en fracturas de meseta tibial presentan arcos de movilidad adecuados para la función, así como un bajo grado de dolor. La angulación en varo se presenta en pacientes con fractura de ambos platillos tibiales.

Background: Tibial plateau fractures account for 1% of all fractures. Ten percent of them involve the medial plateau. The spectrum of lesions ranges from undisplaced fractures to devastating fractures involving the entire tibial plateau, which warrant extensive surgical management. The orthopedic surgery literature suggests that positive functional and radiographic results depend on the type of approach, the quality of reduction and the type of implant used. Material and methods: Ambispective case report: seven patients were enrolled, with fracture of the medial tibial plateau and a posterior fragment. A posterior plate was placed after a posteromedial approach, between August 2012 and August 2013. Fractures were staged according to the Khan classification. Functional and radiographic results were assessed using the Rasmussen scale. Frequency and descriptive statistics were used. Results: Pain was measured using a visual analog scale (VAS), with scores ranging from two to four. Flexion ranged between 40º and 110º, with a minimum extension deficit of 15º and a maximum of 40º. Four subjects had varus deformity, three had valgus deformity. Conclusions: The posteromedial approach and placement of a posterior plate for tibial plateau fractures results in ranges of motion that permit an appropriate function and involve mild pain. Varus angulation occurs in patients with bilateral tibial plateau fractures.

Complicaciones en las fracturas complejas de la meseta tibial y factores asociados / Complications in complex fractures of the tibial plateau and associated factors

Objetivo: identificar factores asociados a complicaciones con el manejo quirúrgico de las fracturas complejas de la meseta tibial. Material y métodos: estudio de casos y controles. Muestra integrada con expedientes de 56 pacientes diagnosticados con fractura compleja de la meseta tibial (tipos IV, V y VI de Schatzker), tiempo de seguimiento promedio de 12.9 ± 3.2 meses (8 a 18), y con uno o más de los siguientes factores de riesgo: edad mayor de 50 años, comorbilidad, tiempo de isquemia mayor de 60 minutos y fractura tipo IV, V o VI. Se consideró caso al paciente que presentara una o más complicaciones. Resultados: la edad promedio fue de 50.1 ± 15.7 años (17 a 87); 35 pacientes (62.5 %) pertenecieron al sexo masculino. Los pacientes con o sin complicaciones mostraron homogeneidad respecto a edad, sexo, lado, tipo de fractura y tiempo de seguimiento; 41.1 % presentó antecedentes patológicos. En todos los procedimientos se utilizó torniquete neumático. El tiempo promedio de cirugía fue de 91 ± 27.2 minutos (40 a 175). Los tratamientos empleados fueron placa más tornillos (53.6 %), fijadores externos más tornillos (35.7 %), doble placa y clavo centromedular. 37.5 % desarrolló complicaciones: infección superficial, 16.1 %; deformidades angulares residuales, 10.7 % (varo, 7.1 %); lesión del nervio peroneo, 5.4 %, pseudoartrosis, 3.5 %; trombosis venosa profunda, 1.8 %. Presentó más de una complicación, 22.2 %. Conclusiones: los factores de riesgo asociados significativamente a complicaciones con el manejo de la fractura compleja de la meseta tibial, fueron la edad mayor de 60 años y el tiempo de isquemia transoperatoria mayor de 120 minutos. Los pacientes en estas condiciones presentaron tres veces más riesgo para desarrollar complicaciones.

BACKGROUND: We undertook this study to identify factors associated with surgical complications of complex fractures of the tibial plateau. METHODS: We designed a case-control study with 56 patients with a diagnosis of complex fracture in the tibial plateau (IV-VI Schatzker) and with 12.9 +/- 3.2 (8-18) months of follow-up. Risk factor exposure was defined as having one or more of the following characteristics: age >60 years; co-morbidity (diabetes mellitus, systemic arterial hypertension); time of [quot ]Kidde[quot ] (>60, >90, >120 min) and fracture type IV, V or VI. A case was considered with one or more complications. Results: Mean age was 50.1 +/- 15.7 (17-87) years old; 35 patients (62.5%) were males. Homogeneity between groups was shown for age, sex, side effects, type of fracture and time of follow-up; 41.1% of patients had pathological history. All surgeries used pneumatic compression (Kidde) for 91 +/- 27.2 (40-175) min. The implants used were plate plus cancellous screws (53.6%), external fixators plus cancellous screws (35.7%), double plate and intramedullary nail. Complications appeared in 37.5% of all patients. Complications reported were superficial infection (16.1%), residual angular deformities (10.7%, varum [7.1%]), peroneal nerve injury (5.4%), non-union (3.5%) and deep venous thrombosis (1.8%); 22.2% of all patients presented more than one complication. CONCLUSIONS: Statistically significant risk factors were age >60 years and pneumatic compression >120 min. Patients with one of these characteristics had a three-times risk of complications. No association was demonstrated between type of fracture, surgical treatment, time between injury and the surgery, with development of complications.