Risk of surgical site infections in OTA/AO type C tibial plateau and tibial plafond fractures: a systematic review and meta-analysis.

Abstract

OBJECTIVES\nTo analyze the current incidence of postoperative infection for OTA/AO type C fractures of the tibial plateau and tibial plafond.\n\n\nDATA SOURCES\nThree medical databases: PubMed/MEDLINE, ScienceDirect, and the Cochrane Library, were utilized in our systematic literature search. Search results were restricted to articles transcribed in English/Spanish and publication date after January 1, 2000, to present day.\n\n\nSTUDY SELECTION\nInclusion criteria were studies reporting postoperative infection data for OTA/AO type 41C, 43C, or equivalent fractures of skeletally mature individuals. A minimum of six total fractures of interest and a frequency of 75% overall were required. Studies reporting on pathologic fractures, stress fractures, or low-energy fracture types were excluded.\n\n\nDATA EXTRACTION\nTwo authors independently screened abstracts, evaluated full-text manuscripts, and extracted relevant data from included studies. Any instances of discrepancy were resolved within the study committee by consensus.\n\n\nDATA SYNTHESIS\nOutcomes were expressed using direct proportions (PR) with a 95% confidence interval (CI). The effects of comorbidities on infection rates were reported using odds ratios (ORs) with a 95% CI. All analyses utilized a DerSimonian-Laird estimate with a random-effects model based on heterogeneity. The presence of publication bias was evaluated using funnel plots and Egger s tests.\n\n\nCONCLUSIONS\nPatients with these specific fractures develop infections at a notable frequency. The rates of deep infections were approximately 6% in tibial plateau fractures and 9% in tibial plafond fractures. These results may be useful as a reference for patient counseling and other future studies aimed at minimizing postoperative infection for these injuries.\n\n\nLEVEL OF EVIDENCE\nPrognostic Level III. See Instructions for Authors for a complete description of levels of evidence.