Retrospective Cohort Study
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World J Clin Cases. Jul 6, 2022; 10(19): 6399-6405
Published online Jul 6, 2022. doi: 10.12998/wjcc.v10.i19.6399
Identification of risk factors for surgical site infection after type II and type III tibial pilon fracture surgery
Hao Hu, Jian Zhang, Xue-Guan Xie, Yan-Kun Dai, Xu Huang
Hao Hu, Jian Zhang, Xue-Guan Xie, Yan-Kun Dai, Xu Huang, Department of Orthopaedics, Huai’an Second People’s Hospital, Huai’an 223300, Jiangsu Province, China
Author contributions: Hu H and Zhang J designed the study; Xie XG drafted the work; Dai YK and Huang X collected the data; Hu H and Zhang J analyzed and interpreted data; and Xie XG and Huang X wrote the manuscript; and all authors read and confirmed the revision of the manuscript.
Institutional review board statement: This study was approved by Huai’an Second People’s Hospital ethics committee.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xu Huang, MD, Attending Doctor, Department of Orthopaedics, Huai’an Second People’s Hospital, No. 62 Huaihai South Road, Huai’an 223300, Jiangsu Province, China. 2212439240@qq.com
Received: February 22, 2022
Peer-review started: February 22, 2022
First decision: March 23, 2022
Revised: April 5, 2022
Accepted: May 16, 2022
Article in press: May 16, 2022
Published online: July 6, 2022
Processing time: 122 Days and 0.4 Hours
Abstract
BACKGROUND

High-energy tibial pilon fractures are complex and severe fractures that are associated with a high risk of infection following open reduction and internal fixation. Infection can negatively impact patient outcomes.

AIM

To compare risk factors for postoperative infection after open reduction and internal fixation for a pilon fracture.

METHODS

Among the 137 patients included, 67 developed a surgical site infection. Demographic, clinical, and surgical factors were compared between the two groups. A binary logistic regression analysis was used to determine the odds ratio (OR) and corresponding 95%CI for significant risk factors for postoperative infection.

RESULTS

The distribution of pathogenic bacteria among the 67 patients who developed a surgical site infection was as follows: Gram-positive, 58.2% (n = 39); Gram-negative, 38.8% (n = 26); and fungal, 2.9% (n = 2). The following factors were associated with postoperative infection (P < 0.05): a Ruedi–Allgower pilon fracture type III (OR = 2.034; 95%CI: 1.109–3.738); a type III surgical incision (OR = 1.840; 95%CI: 1.177–2.877); wound contamination (OR = 2.280; 95%CI: 1.378–3.772); and diabetes as a comorbidity (OR = 3.196; 95%CI: 1.209–8.450).

CONCLUSION

Infection prevention for patients with a Ruedi–Allgower fracture type III, surgical incision type III, wound contamination, and diabetes lowers the postoperative infection risk after surgical management of tibial pilon fractures.

Keywords: High-energy trauma; Pilon fracture; Surgical site infection; Ruedi–Allgower; Risk factors

Core Tip: High-energy tibial pilon fractures are complex and severe fractures that are associated with a high risk of infection following open reduction and internal fixation. In this regard, we identified a Ruedi-Allgower pilon fracture type III, a type III surgical incision, wound contamination; and diabetes as a comorbidity as significant risk factors for postoperative infection. Our findings provide a theoretical basis for prevention strategies to lower the risk of postoperative infection for tibial pilon fractures.