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Trial reportEuropean journal of orthopaedic surgery & traumatology : orthopedie traumatologie2023

Do superficial infections increase the risk of deep infections in tibial plateau and plafond fractures?

Joseph T Patterson, Nathan N O'Hara, Daniel O Scharfstein, Renan C Castillo, Robert V O'Toole, Reza Firoozabadi, METRC

Abstract readClinical Trial
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In one paragraph

Trial report in European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Joseph T PattersonDepartment of Orthopaedic Surgery, Keck School of Medicine at the University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA, 90033-5322, USA. josephp7@usc.edu.ORCID http://orcid.org/0000-0002-7494-7366
Nathan N O'HaraDepartment of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
Daniel O ScharfsteinDepartment of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA.
Renan C CastilloMajor Extremity Trauma and Rehabilitation Consortium Coordinating Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Robert V O'TooleDepartment of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
Reza FiroozabadiDepartment of Orthopedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA.
METRC

Funding

Congressionally Directed Medical Research Programs W81XWH-10-2-0134
6 · The paper itself

Abstract

purposeOpen reduction internal fixation of tibial plateau and pilon fractures may be complicated by deep surgical site infection requiring operative debridement and antibiotic therapy. The management of superficial surgical site infection is controversial. We sought to determine whether superficial infection is associated with an increased risk of deep infection requiring surgical debridement after fixation of tibial plateau and pilon fractures.

methodsThis is a secondary analysis of data from the VANCO trial, which included 980 adult patients with a tibial plateau or pilon fracture at elevated risk of infection who underwent open reduction internal fixation with plates and screws with or without intrawound vancomycin powder. An association of superficial surgical site infection with deep surgical site infection requiring debridement surgery and antibiotics was explored after matching on risk factors for deep surgical site infection.

resultsOf the 980 patients, we observed 30 superficial infections (3.1%) and 76 deep infections (7.8%). Among patients who developed a superficial infection, the unadjusted incidence of developing a deep infection within 90 days was 12.8% (95% confidence interval [CI] 1.3-24.2%). However, after a 3:1 match on infection risk factors, the 90-day marginal probability of a deep surgical site infection after sustaining a superficial infection was 6.0% (95% CI  - 6.5-18.5%, p = 0.35).

conclusionDeep infection after superficial infection is uncommon following operative fixation of tibial plateau and pilon fractures. Increased risk of subsequent deep infection attributable to superficial infection was inconclusive in these data. LEVEL OF EVIDENCE: Prognostic Level II.

Indexed as

Surgical Wound InfectionTibial FracturesAdultAnti-Bacterial AgentsFracture Fixation, InternalHumansOpen Fracture ReductionRisk FactorsTreatment OutcomeVancomycinAnti-Bacterial AgentsVancomycinDeepSuperficialSurgical site infectionTibial plafondTibial plateauVancomycin powder

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.