The Use of Vancomycin Powder in Tibial Plateau Fractures at Lower Risk of Infection

Objective: To determine the effectiveness of vancomycin powder in preventing infection after plate and screw fixation of tibial plateau fractures considered at low risk of infection. Design: Retrospective cohort study. Setting: Single, Level I trauma center. Patients/Participants: This study included 459 patients with tibial plateau fractures (OTA/AO 41-B/C) who underwent open reduction and internal fixation from 2006 to 2018 and were considered at low risk of infection based on not meeting the “high risk” definition of the VANCO trial. Intervention: Vancomycin powder administration on wound closure at the time of definitive fixation. Main Outcome Measurements: Deep surgical site infection with at least 1 gram-positive bacteria culture. Results: Vancomycin powder administration was associated with reduction in gram-positive infection from 4% to 0% (odds ratio, 0.12; 95% confidence interval, 0.04–0.32; P < 0.01). No significant effect was reported in gram-negative only infections, which were observed in 0.3% in the control group, compared with 0.9% in the intervention group (odds ratio, 2.71; 95% confidence interval, 0.11–69; P = 0.54). Methicillin-resistant Staphylococcus aureus was the most common organism isolated in the control group, growing in 9 of 18 infections (50%). Conclusions: Among patients with low-risk tibial plateau fractures, vancomycin powder at the time of definitive fixation showed a reduction in the incidence of gram-positive deep surgical site infection. The observed relative effect was relatively larger than that observed in a previous randomized trial on high-risk fractures. These data might support broadening the indication for use of vancomycin powder to include tibial plateau fractures at low risk of infection. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.