Qing Zhang,1,* Lin Li,1– 3,* Fulin Tao,1 Dawei Wang,1,2 Jinlei Dong,1 Dongsheng Zhou,1,2 Wenhao Song1,2,4 

1Department of Orthopedic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People’s Republic of China; 2Department of Orthopedic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China; 3Department of Orthopedic Surgery, Tengzhou Central People’s Hospital Affiliated to Jining Medical University, Tengzhou, Shandong, People’s Republic of China; 4Shandong Yuhuang Chemical Co., Ltd, Heze, Shandong, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Wenhao Song, Department of Orthopedic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People’s Republic of China, Email songwenhao0308@163.com

Background: Surgical site infection (SSI) after surgery can cause serious sequelae in patients with tibial plateau fractures. This study aims to report the incidence and characteristics of SSI and to investigate the risk factors of SSI in adult patients with closed tibial plateau fracture, especially the relationship between SSI and preoperative hypoalbuminemia.
Methods: We retrospectively reviewed the records of adult patients with closed tibial plateau fracture who were treated at our institution from January 2016 to December 2022. From the medical records, demographic data, surgical data, preoperative results of laboratory examination and postoperative complications extracted. Univariable and multivariable analyses were performed to determine the association between risk factors and SSI after surgery.
Results: In total, 460 patients met inclusion criteria, and 23 patients were diagnosed with SSI, the postoperative infection rate was 5%, with eleven cases (2.4%) were deep SSI and twelve cases (2.6%) were superficial SSI. According to the univariable analysis, current smoking, alcoholism, fracture type (IV-VI), osteofascial compartment syndrome, operative time ≥ 3 hours, intraoperative blood loss ≥ 400 mL, double incisions, more plates, preoperative hypoalbuminemia were investigated to the significant risk factors for SSI. According to the multivariable analysis, fracture type and hypoalbuminemia were independently risk factors for SSI.
Conclusion: Fracture type and preoperative hypoalbuminemia could be predictors of SSI in adult patients with closed tibial plateau fractures. Shorten operation time, reduce intraoperative blood loss, stop smoking and drinking and correct hypoalbuminemia could reduce the risk of postoperative infection.

Keywords: risk factors, surgery, infection, tibial plateau fracture, hypoalbuminemia