Analysis Of Risk Factors Of Postoperative Infection For Complex Tibial Plateau Fracture

Objective: It was very common that complex tibial plateau fractures caused by high energy trauma.Infections had occurred frequently when it after open reduction and internal fixation.However,there is no unified view on the risk factors of postoperative infection.Through retrospective analysis,to explore risk factor of postoperative infection for complex tibial plateau fracture,to provide a theoretical basis for the future to further reduce postoperative infection rate in the clinical work.Methods:Retrospective analysis of clinical data of 293 complex tibial plateau fracture patients whom underwent open reduction and internal fixation between September 2010 to March 2015 in our hospital.The possible risk factors such as gender,age,smoking,diabetes,type of fracture(open/closed),open fracture classification(Gustilo-Anderson classification),classification of soft tissue injury in closed fracture(Tscherne-Gotzen classification),fracture classification(Schatzker?/?),osteofascial compartment syndrome,ASA score,anesthesia,timing of surgery,operative time(?150min/>150min),surgical approach,combined approach or not,internal fixation site were studied.The multivariate logistic regression model was used to analyze the risk factors.Result:Collect the clinical data of 293 complex tibial plateau fracture patients,there were 199 males and 94 females,ranging in age from 17 to 80 years old,with an average of 47.3 years old.There were 253 cases of age?60 years old,40 cases of age>60 years old;105 smokers and 188 non-smokers;20 patients with diabetes,273 cases without diabetes;open fractures in 45 cases,closed fractures in 248 cases;Gustilo-Anderson classification: type ? 21 cases,type ? 19 cases,type ? 5 cases,Tscherne-Gotzen classification: 140 cases of grade 1,96 cases of grade 2,12 cases of grade 3;95 cases of Schatzker V type,198 cases of type ?;11 cases of osteofascial compartment syndrome,282 cases without;ASA grade: grade ? 123 cases,grade ? 118 cases,? grade 35 cases,? grade 17 cases;92 cases of spinal anesthesia,201 cases of general anesthesia;emergency surgery in 35 cases,elective surgery in 258 cases;operation time ?150 minutes in 270 cases,>150 minutes in 23 cases;surgical incision approach: 153 cases of anteriorlaterall approach,29 cases of anteromedial approach,16 cases of anterior median approach,23 cases of posterior approach,50 cases of combined anteriorlateral and antermedial approach,the other 22 cases;72 cases of combined surgical approach,not used in 221 cases;internal fixation site: lateral 159 cases,medial 41 cases,27 cases of posterior,internal and external joint 52 cases,the other 14 cases.12 cases were infected of all the 293 patients after operation,the infection rate was 4.10%.Univariate analysis showed that,fracture type(?2=14.496,P=0.001),fracture classification(?2=4.560,P=0.033),osteofascial compartment syndrome(?2=15.631,P=0.007),operative time(?2=11.233,P=0.001)were correlated with complex tibial plateau fractures postoperative infection.Multivariate analysis showed that,open fractures(Wald=7.909,P=0.002)and osteofascial compartment syndrome(Wald=7.992,P=0.003)are complex tibial plateau fracture risk factors for infection after operation.Conclusion:Open fractures and osteofascial compartment syndrome are complex tibial plateau fracture risk factors for postoperative infection,gender,age,smoking,diabetes,type of fracture,Gustilo-Anderson classification,Tscherne-Gotzen classification,fracture classification,osteofascial compartment syndrome,ASA score,anesthesia,timing of surgery,operative time,surgical approach,combined approach or not,internal fixation site were not.Open fracture patients to be thoroughly debrided,early diagnosis and timely treat the osteofascial compartment syndrome,reduce the incidence of infection.