Surgical site infection in high-energy peri-articular tibia fractures with intra-wound vancomycin powder: a retrospective pilot study.
BACKGROUND
Surgical site infections (SSI) continue to be a significant source of morbidity despite the introduction of perioperative intravenous antibiotics. Our objective was to assess the efficacy of local vancomycin powder on lowering deep SSI rates in high-energy tibial plateau and pilon fractures.


MATERIALS AND METHODS
A retrospective review of all tibial plateau and pilon fractures treated in 2012 at our level I trauma center identified 222 patients. Of these, 107 patients sustained high-energy injuries that required staged fixation, and 93 had minimum 6 month follow-up. Ten patients received 1 gram vancomycin powder directly into the surgical wound at the time of definitive fixation, and the remaining 83 patients served as controls. SSI was defined according to criteria from the Centers for Disease Control. Demographic data, patient comorbidities, injury and treatment details, and infection details were recorded. Descriptive and comparative statistics were performed.


RESULTS
Amongst the vancomycin powder group, 1 patient (10 %) developed a deep SSI; in the control group, 14 (16.7 %) developed deep SSI. The rate of deep SSI between the groups was not statistically significantly different (P = 1.0). The groups were statistically similar with regard to injuries, treatment, comorbidities, and infectious outcomes (P values range = 0.06-1.0).


CONCLUSIONS
The application of local vancomycin powder into surgical wounds of high-energy tibial plateau and pilon fractures did not reduce the rate of deep SSI in this retrospective review. There is a need to find effective, cheap, and widely available methods for prevention of SSI. Basic science and larger prospective clinical studies are needed to further delineate the role of local vancomycin powder as a modality to reduce deep SSI in extremity trauma.
['Singh|Keerat|K|', 'Bauer|Jennifer M|JM|', 'LaChaud|Gregory Y|GY|', 'Bible|Jesse E|JE|', 'Mir|Hassan R|HR|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D000900:Anti-Bacterial Agents D016022:Case-Control Studies D005260:Female D005593:Fracture Fixation, Internal D006801:Humans D008297:Male D008875:Middle Aged D010865:Pilot Projects D011208:Powders D012189:Retrospective Studies D013530:Surgical Wound Infection D013978:Tibial Fractures D014193:Trauma Centers D016896:Treatment Outcome D014640:Vancomycin
Infection Vancomycin powder Tibial plateau Pilon Tibial plafond