Treatment principles for tibial plateau fracture related infection
10.3760/cma.j.cn115530-20250527-00225
- VernacularTitle:胫骨平台骨折相关性感染的诊治经验总结
- Author:
Yanlong ZHANG
1
;
Zhenhua PAN
;
Yong WANG
;
Hongrun WANG
;
Haotian WU
;
Zhiyong HOU
;
Aqin PENG
Author Information
1. 河北医科大学第三医院骨伤科，石家庄 050051
- Publication Type:Journal Article
- Keywords:
Tibial fractures;
Infection;
Osteomyelitis;
Clinical protocols
- From:
Chinese Journal of Orthopaedic Trauma
2025;27(11):943-951
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the clinical treatment principles for tibial plateau fracture related infection (TPFRI).Methods:A retrospective study was used to analyze the clinical data of 47 patients with TPFRI who had been admitted to The Third Hospital of Hebei Medical University from May 2015 to May 2022. There were 33 males and 14 females, with an age of (49.3±9.5) years. By admission, 32 tibial plateau fractures got healed while 15 ones remained unhealed. According to the site of infection, TPFRI was classified into 3 categories: arthritic type (9 cases), adjacent articular type (28 cases), and distal articular type (10 cases). Individualized reconstruction plans were made according to fracture union, bone and soft tissue defects, and infection involvement of the knee joint. The knee function was assessed by the modified Hospital for Special Surgery (HSS) criteria at the final follow-up. The fracture union and complications were recorded.Results:All patients were followed up for (37.4±11.7) months. The infection was controlled and the fractures got united after (4.6±1.4) months in the 15 patients whose tibial plateau fractures remained unhealed by admission. In the 32 cases whose tibial plateau fractures got healed by admission (except for the 7 cases without bone defects, 1 case undergoing femoral condyle amputation and 1 case undergoing tibial flip amputation), respectively, Masquelet technique was used in 5 cases, Ilizarov bone transport in 3 cases, filling with an astrocnemius muscle flap or a myocutaneous flap in 5 cases, semi-open bone grafting in 1 case, open bone cement rod technique in 1 case, platelet-rich plasma combined with negative pressure drainage in 1 case, and knee arthrodesis in 7 cases to reconstruct their bone and soft tissue defects. At the final follow-up, the knee function was evaluated based on the modified HSS scoring as excellent in 28 cases, as good in 15 cases, as moderate in 3 cases and as poor in 1 case. The number of the patients with excellent or good knee function was significantly larger in the adjacent articular type and distal articular type than in the arthritic type ( P<0.05). The number of the patients with excellent or good knee function was significantly larger in those whose tibial plateau fractures remained unhealed by admission than in those whose tibial plateau fractures got healed by admission ( P<0.05). All patients did not experience such complications as open fat liquefaction, bone nonunion, lower limb deep vein thrombosis, or pulmonary embolism. Conclusions:In the treatment of TPFRI, individualized treatment plans should be made to improve infection control, accelerate functional recovery of the knee joint, and reduce incidence of complications, taking into consideration such factors as fracture union, bone and soft tissue defects, and infection involvement of the knee joint.
