## 4 Discussion  
There is a variation in the incidence of postoperative infection associated with tibial plateau fixation in the literature, ranging from 2.6 to 45.0% [6; 12]. Systematic reviews like that of [PERSON] et al. [3] report an incidence of 12.3% after combining different sources. Postoperative infection in this sample is still higher than what is reported, and multiple factors could influence these findings, like higher ASA scores or many patients needing an external fixation bridge treatment (which means higher risk of soft tissue complications) [13; 14; 15]. In this context, the authors sought to highlight how Schatzker II-type fractures were associated with a higher risk of infection in this sample. The fact that the study was conducted at a training university hospital for residents, where less complex fracture patterns are usually treated by less experienced surgeons, entailed a longer surgical time related to this type of fractures, and thus a higher SSI rate. In fact, extended surgical time is consistently an independent variable associated with higher risk for infection, being constantly reported as such in the literature [6; 13; 16; 17]. While it is known that extending the surgery by as little as half an hour can exponentially raise the infection risk [18], the baseline for every surgery's optimal duration is still blurred. Some orthopedic procedures like spine or distal tibia surgeries have well-established ideal surgical times [19; 20] and others, like tibial plateau, still must use the NNIS system as a reference, which has proven to be poorly related to outcomes in this kind of surgery [6]. Because of the lack of this baseline, the evaluation of the surgical time in this sample is not optimal, which is a limitation of this study considering the importance of surgical time. In contrast to what is usually found in the literature [6; 12; 13], open fractures were not found to increase the risk of infection in this sample. The administration of wide spectrum antibiotics immediately following the arrival of infection in the emergency room may have a role in these findings. Additionally, patients with open fractures often waited for longer before definitive surgery with the intention of allowing soft tissue healing, so these patients could have undergone surgery with their soft tissues in better condition when compared to closed fracture patients, affecting the results. \begin{table}
\begin{tabular}{c c c c c} \hline \hline  & **Group A** & **Group B** & **Group C** & \(p\) **Value \({}^{*}\)** \\ \hline n & 52 & 37 & 59 & \\ Mean (SD) age & 50.1 (15) & 51.3 (15) & 43.8 (15) & 0.03 \\ Male: female ratio & 1.3:1 & 3:1 & 2.4:1 & 0.9 \\ Mean ASA & 1 & 2 & 1 & 0.001 \\ Mean Schatzker & II & VI & II & 0.6 \\ Open fracture & 1 (2\%) & 2 (5\%) & 3 (5\%) & 0.7 \\ Use of external fixation & 5 (9\%) & 5 (13\%) & 10 (16\%) & 0.8 \\ Mean (SD) surgical time (in minutes) & 157.5 (62) & 185.3 (74) & 188.5 (76) & 0.2 \\ Incidence of prolonged surgical time & 7.6\% & 32.4\% & 28.8\% & 0.1 \\ Use of bone graft & 21 (40\%) & 20 (54\%) & 30 (50\%) & 0.3 \\ \hline \hline \end{tabular}
\end{table} 
Table 2: Characteristics of the three studied groups. Regarding perioperative prophylaxis, ceftrixone-teicoplanin (group C) showed the lowest incidence of SSI even when adjusted by cofounding factors and compared against group A + group B patients. Ceftrixone has high bactericidal speed, some resistance to betalactamases, elevated protein binding, and a long half-life [21]. Evidence suggests that ceftrixone is a good alternative to safely cover methicillin-sensible _Staphylococcus aureus_, which was the most isolated microorganism in the tissue samples in this study, as well as in the literature [22; 23]. Some evidence even suggests that ceftrixone could become the treatment of choice for MSSA because it can be administered less frequently and has less toxicity [24]. The literature has reported an in vivo half-life of approximately 1 h for meropenem [25].