Incisional negative pressure wound therapy may not protect against post-operative surgical site complications in bicondylar tibial plateau fractures

Taylor R Johnson; Yousi A Oquendo; Ryan Seltzer; Noelle L Van Rysselberghe; Julius A Bishop; Michael J Gardner

doi:10.1007/s00590-023-03782-w

Incisional negative pressure wound therapy may not protect against post-operative surgical site complications in bicondylar tibial plateau fractures

Eur J Orthop Surg Traumatol. 2024 Feb;34(2):1173-1181. doi: 10.1007/s00590-023-03782-w. Epub 2023 Nov 22.

Authors

Taylor R Johnson¹, Yousi A Oquendo², Ryan Seltzer², Noelle L Van Rysselberghe², Julius A Bishop², Michael J Gardner²

Affiliations

¹ Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063, USA. johntr@Stanford.edu.
² Department of Orthopaedic Surgery, Stanford University, 450 Broadway, Redwood City, CA, 94063, USA.

PMID: 37989870
DOI: 10.1007/s00590-023-03782-w

Abstract

Purpose: To determine if incisional negative pressure wound therapy is protective against post-operative surgical site complications following definitive fixation of bicondylar tibial plateau fractures.

Methods: A retrospective analysis of patients diagnosed with an acute bicondylar tibial plateau fracture (AO/OTA 41-C) undergoing ORIF from 2010 to 2020 was performed. Patients received either a standard sterile dressing (SD) or incisional negative pressure wound therapy (iNPWT). Primary outcomes included surgical site infection, osteomyelitis, and wound dehiscence. Secondary outcomes included non-union and return to the operating room. Multivariate logistic regression analyses were performed.

Results: 180 patients were included and 22% received iNPWT (n = 40) and 78% received standard dressings (n = 140). iNPWT was more common in active smokers (24.7% vs. 19.3%, p = 0.002) and the SD group was more likely to be lost to follow up (3.6% vs. 0%, p = 0.025). iNPWT was not protective against infection or surgical site complications, and in fact, was associated with higher odds of post-operative infection (OR: 8.96, p = 0.005) and surgical site complications (OR:4.874, p = 0.009) overall. Alcohol abuse (OR: 19, p = 0.005), tobacco use (OR: 4.67, p = 0.009), and time to definitive surgery (OR = 1.21, p = 0.033) were all independent risk factors for post-operative infection.

Conclusion: In this series of operatively treated bicondylar tibial plateau fractures, iNPWT did not protect against post-operative surgical site complications compared to conventional dressings. Tobacco use, alcohol abuse, and time to definitive surgery, were independent risk factors for post-operative infection. Further studies are needed to determine if iNPWT offers a protective benefit in exclusively high-risk patients with relevant medical and social history.

Keywords: Lower extremity fracture; Negative pressure wound therapy; Non-union; Osteomyelitis; Surgical Site Infection; Tibial Plateau fracture.

MeSH terms

Alcoholism* / etiology
Fracture Fixation, Internal / adverse effects
Humans
Negative-Pressure Wound Therapy*
Retrospective Studies
Surgical Wound Infection / etiology
Surgical Wound Infection / prevention & control
Tibial Fractures* / etiology
Tibial Fractures* / surgery
Tibial Plateau Fractures*