Treatment of postoperative infection of tibial plateau fracture at different stages

Abstract

Objective \nTo investigate the treatment options for early and delayed postoperative infection of tibial plateau fracture. \n \n \nMethods \nA retrospective case series study was conducted to analyze 21 patients with postoperative infection of tibial plateau fracture admitted to the Second Affiliated Hospital of Medical College of Zhejiang University from February 2013 to February 2017. There were 16 males and five females, aged 28-68 years, with an average age of 51.9 years. Infection control was achieved in all patients through debridement and local application of antibiotic calcium sulfate or bone cement in all patients and gastrocnemius muscle flap transfer was conducted if necessary. The implants were retained in the 12 patients with early infection through thorough debridement and antibiotic therapy. Of all the nine patients with delayed infection, the implant of one patient was removed after local wound dressing until fracture union and the following debridement closure was performed; two patients with severe damage of knee joint had no chance of reconstruction, with one patient treated with lower femoral amputation and another with replacement of plate by external fixator at stage I and arthrodesis at stage II. The implants were replaced by external fixator followed by debridement and antibiotic therapy in the remaining six patients with delayed infection, among which stage II bone grafting was performed in three patients with bone defect. Infection, bone healing and knee function score of Hospital for Special Surgery (HSS) were evaluated in all patients at regular intervals. \n \n \nResults \nAll patients were followed up for 18-60 months, with an average of 37.4 months. All patients were treated with antibiotic calcium sulfate or bone cement to control infection. Ten patients with infection underwent gastrocnemius muscle flap transfer, and the wounds were healed well with no recurrence of fracture and infection. The implants of 12 patients with early infection were successfully retained, and the fractures were healed. According to HSS scoring criteria, the knee joint function results were excellent in seven patients, good in three, and moderate in two, with an overall excellent and good rate of 83% (10/12). Infection was controlled in nine patients with delayed infection, and fractures or bone defects were healed in seven patients with delayed infection except patients receiving amputation and joint fusion. According to HSS scoring criteria, knee joint function results were excellent in one patient, good in three, moderate in two and poor in one, with an excellent and good rate of 57% (4/7). \n \n \nConclusions \nPatients with early postoperative infection of tibial plateau fracture may attempt to retain the implants through early debridement and antibiotic therapy. For patients with delayed infection, although implants may also be retained in stable cases with ongoing fracture healing, removal of implants instead by external fixator is recommended and infection can mostly be controlled by debridement and antibiotic therapy. Meanwhile, gastrocnemius muscle flap transfer and antibiotic calcium sulfate or bone cement contributing to the control of infection can achieve good clinical results. \n \n \nKey words: \nTibial fractures;\xa0Infection;\xa0Treatment