AIM: Overweight and obese patients present unique pathophysiological characteristics that may increase the risk of surgical site infection (SSI) following orthopedic surgery. However, the specific risk factors for SSI in overweight and obese patients with tibial plateau fractures remain unclear. This study aimed to identify the independent risk factors for SSI after open reduction and internal fixation (ORIF) in this high-risk population.

METHODS: A total of 300 patients with tibial plateau fractures who underwent ORIF were retrospectively analyzed. Patients were divided into three groups according to body mass index (BMI): control group (BMI <25 kg/m², n = 50), overweight group (25 ≤ BMI < 30 kg/m², n = 194), and obese group (BMI ≥30 kg/m², n = 56). To evaluate the influencing factors of SSI in overweight and obese patients, those with BMI ≥25 kg/m² were further classified into an infection group (n = 30) and a non-infection group (n = 220) based on postoperative infection status. All patients were followed for one year to document the occurrence of SSI. Logistic regression analysis was performed to identify the independent factors associated with SSI after ORIF in overweight and obese patients.

RESULTS: A total of 31 patients developed postoperative SSI (10.33%), including 8 cases of deep SSI and 23 cases of superficial SSI. There was a significant difference in the incidence of SSI among the three groups (p = 0.042), with the overweight group exhibiting the highest incidence. Among overweight and obese patients, the proportions of open fracture, compartment syndrome, and operation time were significantly higher in the infection group than in the non-infection group (p = 0.022, 0.017, and <0.001, respectively). Multivariate logistic regression analysis showed that open fracture (odds ratio [OR] = 6.012, 95% confidence interval [CI]: 1.393–25.945, p = 0.016), compartment syndrome (OR = 3.276, 95% CI: 1.151–9.322, p = 0.026), and operation time >178 min (OR = 5.012, 95% CI: 1.907–13.172, p = 0.001) were independent risk factors for postoperative SSI after ORIF in overweight and obese patients.

CONCLUSIONS: Overweight and obese patients with tibial plateau fractures have a relatively high incidence of SSI. Open fracture, compartment syndrome, and operation time >178 min significantly increase the risks of postoperative SSI after ORIF in overweight and obese patients.