Open Ankle Fractures: What Predicts Infection? A Multicenter Study
Margaret E. CookePaul TornettaReza FiroozabadiHeather A. VallierDouglas S. WeinbergTimothy B. AltonMegan R. DillmanJerald R. WestbergAndrew H. SchmidtMichael J. BosseDaniel LeasMichael T. ArchdeaconRafael KakazuIfeanyi N. NzegwuRobert V. O’TooleTimothy CostalesMax CoaleBrian MullisRashad H. UsmaniKenneth A. EgolStephen KottmeierDavid SandersCliff JonesAnna N. MillerDaniel S. HorwitzHarish KempegowdaSaam MorshedTigist BelayeDavid Teague
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Abstract:
To identify the patient, injury, and treatment factors associated with an acute infection during the treatment of open ankle fractures in a large multicenter retrospective review. To evaluate the effect of infectious complications on the rates of nonunion, malunion, and loss of reduction.Multicenter retrospective review.Sixteen trauma centers.One thousand and 3 consecutive skeletally mature patients (514 men and 489 women) with open ankle fractures.Fracture-related infection (FRI) in open ankle fractures.The charts of 1003 consecutive patients were reviewed, and 712 patients (357 women and 355 men) had at least 12 weeks of clinical follow-up. Their average age was 50 years (range 16-96), and average BMI was 31; they sustained OTA/AO types 44A (12%), 44B (58%), and 44C (30%) open ankle fractures. The rate FRI rate was 15%. A multivariable regression analysis identified male sex, diabetes, smoking, immunosuppressant use, time to wound closure, and wound location as independent risk factors for infection. There were 77 cases of malunion, nonunion, loss of reduction, and/or implant failure; FRI was associated with higher rates of these complications (P = 0.01).Several patient, injury, and surgical factors were associated with FRI in the treatment of open ankle fractures.Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.Keywords:
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Abstract Purpose Controversy exists regarding the acute effect of non-steroidal anti-inflammatory drugs (NSAIDs) on early fracture healing. The purpose of this study was to analyze the rate of nonunion or delayed union in patients with fifth metatarsal (5 th MT) fractures. We hypothesize that the use of NSAIDs would increase the rate of nonunion/delayed union in 5 th MT fractures. Methods Using PearlDiver, a national insurance database was analyzed. ICD codes were used to identify patients diagnosed with 5 th MT fracture from 2007-2018. Patients were grouped by initial management (nonoperative vs. open reduction and internal fixation (ORIF) or non/malunion repair within 60 days) and sub-grouped by whether they had been prescribed at least one pre-defined NSAID. Subsequent ORIF or nonunion/malunion repair operative intervention was used as a surrogate for fracture nonunion/delayed union. Results Of the 10,991 subjects with a diagnosis of 5 th MT, 10,626 (96.7%) underwent initial nonoperative treatment, 1,409 of which (13.3%) received prescription NSAIDS within 60 days of diagnosis. 16/1,409 (1.14%) subjects who received anti-inflammatory prescriptions underwent ORIF or repair of non/malunion at least 60 days after diagnosis while 46/9,217 (0.50%; P=0.003483 ) subjects who did not receive anti-inflammatory prescriptions underwent ORIF or repair of non/malunion at least 60 days after diagnosis. In the 365 subjects who underwent early repair/ORIF (within 60 days), there was no significant difference in the rate of nonunion/delayed union. Conclusion The rate of nonunion/delayed union of 5 th MT fractures was significantly higher in subjects receiving NSAIDs within 60 days of initial diagnosis in patients managed non-operatively. Level of evidence Level III
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Our purpose was to determine the rates of lower extremity nonunion and malunion over 17 years in South Carolina. Our hypothesis was that malunions and nonunions decreased over time due to improved access to trauma centers and improved orthopaedic surgical training. The South Carolina Department of Budget and Control Hospital Discharge Database was queried between 1998-2014 and yielded a total of 4,994 malunions and 16,454 nonunions. Malunions increased from 1.2% (1998) to 1.8% (2010); nonunions increased from 4.0% (1999) to 5.8% (2011). Older age and gender were predictive of malunion and nonunion. This study identified females as having a higher odds ratio for malunion or nonunion; higher nonunion rates in worker's compensation or government payer status; and older age as incurring greater risks for sustaining fractures or developing a malunion or nonunion. There was increased prevalence of nonunion and malunion despite improved access to trauma centers and trained orthopaedic trauma surgeons. (Journal of Surgical Orthopaedic Advances 29(3):129-134, 2020).
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From 1984 to 1995, 37 patients with nonunion, malunion, and combined nonunion malunion of the pelvic ring were treated. Included among the patients were many different initial injury paterns and subsequent variable combinations of malunion and malpositioned nonunion. The typical surgical repair was performed in multiple stages and often created uniquely to solve a patient's particular problem. Thirty-two of 37 patients were satisfied with their outcome, although 19% of the patients suffered complications.
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Objective: To report the effect of treatment for the varus malunion and nonunion of the Pilon fractures by a two-staged osteotomy, bone grafting and internal fixation. Methods: Twenty-five cases of varus malunion and nonunion Pilon fractures were treated by osteotomy and bone grafting (artificial bone, autograft bone ilia ) between 1996.7～2001.12, therapeutic effect were followed up by the way of postoperative objective, subjective and X-ray. Results: All patients were followed up for 7～26 months .These fractures healed up and the function of ankle joint excellent and good rate was 96%,satisfactory reduction were obtained. Conclusions: It is one of the ideal methods to treat Pilon fractures complication of varus malunion and nonunion by a two-staged osteotomy, bone grafting.and internal fixation.
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This retrospective study was performed to assess the incidence of complications of operative treatment of phalangeal fractures. Risk factors for the development of complications were also investigated. Records and radiographs of 350 patients with 666 operatively treated phalangeal fractures were studied. Minimum follow-up was 1 year. A total of 176 fractured fingers were amputated primarily or secondarily, leaving 490 fractures for follow-up. Ninety-three fractures were treated conservatively. Nonunion necessitating reoperation developed in 6% (31/490) of fractures, malunion in 9% (44/490) and infection in 2% (8/490). Infection, segmental bone loss and (neuro)vascular injury predisposed to nonunion and replantation predisposed to malunion. There was a statistical correlation between the use of external fixation and malunion. Nonunion, malunion, and infection rates were similar to other studies.
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