Impression fracture of the lateral condyle of tibial plateau complicated by acute peri-implant infection: a case report

Abstract

Introduction. Deep infection after open osteosynthesis of tibial plateau fractures occurs in 9.9%. This rate is significantly higher than in surgical treatment of closed injuries of other localizations. Many authors consider it necessary to improve management protocols for patients with complex plateau fractures in order to minimize or prevent the development of infectious complications.

Aims of the study: 1) to discuss the treatment tactics of a patient with an intraarticular fracture of the tibial plateau after osteosynthesis complicated by the development of early deep surgical site infection (SSI), using clinical case as an example; 2) to carry out the analysis of medical care defects.

Case description. A 71-year-old patient with compromised somatic status underwent osteosynthesis with a buttress plate and allogeneic bone grafting of the metaphyseal defect on the 12^th day after injury. In 7 days after the occurrence of signs of infection, a revision surgery was performed. Later, a number of consecutive revisions were performed due to recurrences of the infectious process. The complex of measures against SSI included the use of vacuum drainage systems and antibacterial spacers. As a result, the wounds had healed. Two years after the injury, the patient had a good functional result.

Conclusion. The presented clinical case has shown that even if the treatment tactic for early peri-implant infection is chosen correctly, there are several defects in our routine practice. First of all, inaccurate sampling of material for bacteriological study and inadequate duration of antibacterial therapy are to be mentioned. To successfully treat infectious complications of osteosynthesis, a team of like-minded specialists including traumatologists as well as physicians, microbiologists and clinical pharmacologists is needed. Undoubtedly, surgical treatment of fractures might develop into infectious complications. Their diagnosis and treatment are often accompanied by a number of various mistakes. The most important points are early radical revision of the postoperative wound, etiotropic antibacterial therapy, maintaining stability of fixation after primary osteosynthesis. If these standards are complied with, the outcome of surgical treatment might be satisfying even with such a severe complication as peri-implant infection. At the same time, we are planning further researches aimed at improving algorithms and tactics for surgical treatment of infectious complications, reducing surgery trauma level and upgrading quality of primary osteosynthesis.

Keywords

tibial plateau fracture / osteosynthesis / peri-implant infection / surgical site infection / fracture-related infection (FRI) / confirmatory criteria for FRI / suggestive criteria for FRI

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