Abstract: Objectives: Comparison of surgical site infection (SSI) rates in tibial plateau fractures with acute compartment syndrome treated with single-incision (SI) versus dual-incision (DI) fasciotomies.
Design: Retrospective cohort study.
Setting: Two, Level-1, academic, trauma centers.
Patients: Between January 2001 and December 2021, one-hundred ninety patients with a diagnosis of tibial plateau fracture and acute compartment syndrome met inclusion criteria (SI: n = 127, DI: n = 63) with a minimum of 3-month follow-up after definitive fixation.
Intervention: Emergent 4-compartment fasciotomy, using either SI or DI technique, and eventual plate and screw fixation of the tibial plateau.
Outcomes: The primary outcome was SSI requiring surgical debridement. Secondary outcomes included nonunion, days to closure, method of skin closure, and time to SSI.
Results: Both groups were similar in demographic variables and fracture characteristics (all P > 0.05). The overall infection rate was 25.8% (49 of 190), but the SI fasciotomy patients had significantly fewer SSIs compared with the DI fasciotomy patients [SI 18.1% vs. DI 41.3%; P < 0.001; OR 2.28, (confidence interval, 1.42-3.66)]. Patients with a dual (medial and lateral) surgical approach and DI fasciotomies developed an SSI in 60% (15 of 25) of cases compared with 21.3% (13 of 61) of cases in the SI group ( P < 0.001). The nonunion rate was similar between the 2 groups (SI 8.3% vs. DI 10.3%; P = 0.78). The SI fasciotomy group required fewer debridement's ( P = 0.04) until closure, but there was no difference in days until closure (SI 5.5 vs. DI 6.6; P = 0.09). There were zero cases of incomplete compartment release requiring return to the operating room.
Conclusions: Patients with DI fasciotomies were more than twice as likely to develop an SSI compared with SI patients despite similar fracture and demographic characteristics between the groups. Orthopaedic surgeons should consider prioritizing SI fasciotomies in this setting.
Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Competing Interests: The authors report no conflict of interest.
(Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
References: Osborn CPM, Schmidt AH. Management of acute compartment syndrome. J Am Acad Orthop Surg. 2020;28:e108–e114.
Osborn PM, Schmidt AH. Diagnosis and management of acute compartment syndrome. J Am Acad Orthop Surg. 2021;29:183–188.
Schneiderman BA, O'Toole RV. Compartment syndrome in high-energy Tibial Plateau Fractures. Orthop Clin North Am. 2022;53:43–50.
Barei DP, Nork SE, Mills WJ, et al. Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique. J Orthop Trauma. 2004;18:649–657.
Blair JA, Stoops TK, Doarn MC, et al. Infection and nonunion after fasciotomy for compartment syndrome associated with tibia fractures: a matched cohort comparison. J Orthop Trauma. 2016;30:392–396.
Parkkinen M, Madanat R, Lindahl J, et al. Risk factors for deep infection following plate fixation of proximal tibial fractures. J Bone Joint Surg Am. 2016;98:1292–1297.
Reverte MM, Dimitriou R, Kanakaris NK, et al. What is the effect of compartment syndrome and fasciotomies on fracture healing in tibial fractures? Injury. 2011;42:1402–1407.
Thabet AM, Simson JE, Gerzina C, et al. The impact of acute compartment syndrome on the outcome of tibia plateau fracture. Eur J Orthop Surg Traumatol. 2018;28:85–93.
Neal M, Henebry A, Mamczak CN, et al. The efficacy of a single-incision versus two-incision four-compartment fasciotomy of the leg: a cadaveric model. J Orthop Trauma. 2016;30:e164–e168.
Bible JE, McClure DJ, Mir HR. Analysis of single-incision versus dual-incision fasciotomy for tibial fractures with acute compartment syndrome. J Orthop Trauma. 2013;27:607–611.
Maheshwari R, Taitsman LA, Barei DP. Single-incision fasciotomy for compartmental syndrome of the leg in patients with diaphyseal tibial fractures. J Orthop Trauma. 2008;22:723–730.
Crist BD, Della Rocca GJ, Stannard JP. Compartment syndrome surgical management techniques associated with tibial plateau fractures. J Knee Surg. 2010;23:3–7.
NHSN TCfDC. CDC/NHSN Surveillance Definitions for Specific Types of Infections. Atlanta, GA: CDC.gov; 2023.
Dubina AG, Paryavi E, Manson TT, et al. Surgical site infection in tibial plateau fractures with ipsilateral compartment syndrome. Injury. 2017;48:495–500.
Morris BJ, Unger RZ, Archer KR, et al. Risk factors of infection after ORIF of bicondylar tibial plateau fractures. J Orthop Trauma. 2013;27:e196–e200.
Henkelmann R, Frosch KH, Mende M, et al. Risk factors for deep surgical site infection in patients with operatively treated Tibial Plateau Fractures: a retrospective multicenter study. J Orthop Trauma. 2021;35:371–377.
Jia P, Lu FC, Ullah K, et al. Angle stable interlocking intramedullary nails for Tibial Plateau Fractures. Orthop Surg. 2018;10:115–120.
Wright DJ, Etiz B, Scolaro JA. Combined plate and nail fixation of bicondylar tibial plateau fractures. Injury. 2021;52:3104–3110.
Gosling T, Schandelmaier P, Muller M, et al. Single lateral locked screw plating of bicondylar tibial plateau fractures. Clin Orthop Relat Res. 2005;439:207–214.
Metcalfe D, Hickson CJ, McKee L, et al. External versus internal fixation for bicondylar tibial plateau fractures: systematic review and meta-analysis. J Orthop Traumatol. 2015;16:275–285.
Merchan N, Ingalls B, Garcia J, et al. Factors associated with surgical site infections after fasciotomy in patients with compartment syndrome. J Am Acad Orthop Surg Glob Res Rev. 2022;6:e22.00002.
Agel J, Robertson AJ, Novak AA, et al. The fallacy of follow-up: when orthopaedic trauma patients actually return to clinic. J Bone Joint Surg Am. 2021;103:469–476.
Processing Request
No Comments.