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

• Published in: European journal of orthopaedic surgery & traumatology 2024-02, Vol.34 (2), p.1173-1181
• Main Authors: Johnson, Taylor R., Oquendo, Yousi A., Seltzer, Ryan, Van Rysselberghe, Noelle L., Bishop, Julius A., Gardner, Michael J.
• Format: Article
• Language: English
• Subjects: Alcohol abuse; Infections; Medicine; Medicine & Public Health; Original Article; Surgical Orthopedics; Traumatic Surgery; Wound healing
• ISSN: 1432-1068; 1633-8065; 1432-1068
• DOI: 10.1007/s00590-023-03782-w

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.