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Wang H, Liu Y, Shi Z, Wang D, Zhang H, Diao S, Xu X, Waheed MZ, Lu T, Zhou J. Intrawound application of vancomycin reduces the proportion of fracture-related infections in high-risk tibial plateau fractures. Injury 2023; 54:1088-1094. [PMID: 36740472 DOI: 10.1016/j.injury.2023.01.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/24/2023] [Accepted: 01/30/2023] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Despite the improvements in surgical techniques and the use of prophylactic intravenous antibiotics, the fracture-related infection (FRI) incidence after high-risk tibial plateau fractures remains high. This study aimed to evaluate the clinical effect of the intrawound application of vancomycin on the FRI after high-risk tibial plateau fracture surgery. METHODS A total of 243 patients who underwent high-risk tibial plateau fracture surgery from May 2013 to June 2021 were retrospectively reviewed. Of these, 233 cases were enrolled. Considering the preoperative patient condition, surgeons applied vancomycin powder directly into the surgical site before wound closure in 105 cases (intrawound application of vancomycin powder with preoperative intravenous cephalosporin). The remaining 128 cases served as the control group (preoperative intravenous cephalosporin alone). Clinical data and surgical details were recorded. The Cox proportional hazards regression analysis was used to assess risk factors for FRI. The Kaplan-Meier method and the log rank test illustrated the infection status of patients based on the application of intrawound vancomycin. The primary outcome was an FRI within one year. Secondary outcomes included bacterial culture and vancomycin-related complications. RESULTS Our study demonstrated a significant difference in the incidence of FRI between the vancomycin group and the control group (3.8% versus 10.9%; p=0.041). Multivariable Cox regression showed the intrawound application of vancomycin powder decreased the rate of FRI. There were no complications related to intrawound vancomycin observed during follow-up. The presence of Gram-positive FRI was higher in the control group compared with the vancomycin group. CONCLUSIONS Intrawound application of vancomycin was associated with a significant lower rate of FRI after high-risk tibial plateau fracture surgery compared to the control group.
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Affiliation(s)
- Hanzhou Wang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing 100020, PR China
| | - Yang Liu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing 100020, PR China
| | - Zongxin Shi
- Department of Orthopedic Surgery, Beijing Liangxiang Hospital, Beijing 102446, PR China
| | - Dong Wang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing 100020, PR China
| | - Hui Zhang
- Department of Orthopedic Surgery, Beijing Liangxiang Hospital, Beijing 102446, PR China
| | - Shuo Diao
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing 100020, PR China
| | - Xiaopei Xu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing 100020, PR China
| | - Muhammad Zeeshan Waheed
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing 100020, PR China
| | - Tianchao Lu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing 100020, PR China
| | - Junlin Zhou
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing 100020, PR China.
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Ding Y, Wang D, Waheed MZ, Zhou JL. Three-dimensional fracture mapping and analysis of coronal fractures in AO/OTA types 33-B3 and C3. J Orthop Surg Res 2022; 17:438. [PMID: 36183139 PMCID: PMC9526965 DOI: 10.1186/s13018-022-03327-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background Although the relatively high incidence of coronal fractures in the supracondylar–intercondylar fractures is well established, little is currently known about the morphology of those fractures. Herein, we characterized the coronal fractures in AO/OTA type 33-C3 and assessed their differences with Busch–Hoffa fractures (33-B3).
Methods We retrospectively collected 61 cases of AO/OTA type 33-B or C fractures with coronal plane fragments and generated three-dimensional fracture maps of those with coronal fractures based on CT imaging and measured angle α (the angle between the coronal fracture and the posterior condyle axis in the axis plane) and angle β (the angle between the coronal fracture and the posterior femoral cortex in the sagittal plane). Results Thirty-three cases (32%) of AO/OTA type 33-C fractures contained coronal fragments. Most of them were type 33-C3 fractures. Angles α and β for type 33-C3 were significantly smaller than for type B3 at the lateral condyle, while the angles at the medial condyle were not significantly different. The fracture maps showed that the coronal fractures and the articular comminution area were more anterior in type 33-C3. Conclusions The incidence of coronal fractures was 32% and 67% in AO/OTA types 33-C and 33-C3, respectively. Our findings suggest that coronal fractures differed between both types, emphasizing the potential need for different treatment approaches.
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Affiliation(s)
- Yin Ding
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Dong Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Muhammad Zeeshan Waheed
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Jun-Lin Zhou
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
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Yao P, Liu Y, Shan L, Zhao Y, Wang D, He Y, Wang H, Zeeshan Waheed M, Lu T, Zhou J. Intra- and inter-observer reliability assessment of widely used classifications and the "Ten-segment classification" of tibial plateau fractures. Knee 2022; 35:149-156. [PMID: 35313243 DOI: 10.1016/j.knee.2022.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 01/17/2022] [Accepted: 03/03/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Ten-segment classification provides a different approach to the evaluation of tibial plateau fractures. The purpose of this study was to assess the intra- and inter-observer reliability of three widely used classification systems (Schatzker, Arbeitsgemeinschaft für Osteosynthesefragen (AO/OTA), and the updated three-column concept (uTCC)) with ten-segment classification in two-dimensional computed tomography (2D-CT) and three-dimensional computed tomography (3D-CT). METHOD Ninety 2D-CT and 3D-CT scans of patients with tibial plateau fractures were included in this retrospective cohort study. The included data were independently classified by six observers of different years of seniority and were independently observed and classified again after eight weeks. Inter-observer and intra-observer reliability of the four fracture classifications made by the six observers was analyzed using the kappa statistic. Kappa values were interpreted according to the categorical rating by Landis and Koch. RESULTS When the inter-observer reliability was based on 2D-CT/3D-CT analysis, the mean Kappa values for the Schatzker, AO/OTA, uTCC, and ten-segment classification were 0.64/0.66, 0.56/0.59, 0.53/0.65, and 0.60/0.73, respectively. When intra-observer reliability was based on 2D-CT/3D-CT, the mean Kappa values for the Schatzker, AO/OTA, uTCC, and ten-segment classification were 0.68/0.83, 0.69/0.83, 0.74/0.85, and 0.80/0.91, respectively. CONCLUSIONS The use of 3D-CT is important for the reliable diagnosis and recognition of tibial plateau fracture features compared to 2D-CT. When using 3D-CT, ten-segment classification showed high intra- and inter-observer agreement.
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Affiliation(s)
- Peifeng Yao
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China; Capital Medical University, Beijing 100020, China
| | - Yang Liu
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Lei Shan
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yanrui Zhao
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Dong Wang
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yuanming He
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China; Capital Medical University, Beijing 100020, China
| | - Hanzhou Wang
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China; Capital Medical University, Beijing 100020, China
| | - Muhammad Zeeshan Waheed
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China; Capital Medical University, Beijing 100020, China
| | - Tianchao Lu
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China; Capital Medical University, Beijing 100020, China
| | - Junlin Zhou
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China; Capital Medical University, Beijing 100020, China.
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