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Study identifies predictors of infection after open ankle fracture

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SAN DIEGO — Results of a retrospective review presented here cited diabetes and the use of immunosuppressant medications among the patient, injury and treatment risk factors for infection following open ankle fracture.

“Male gender, diabetes, immunosuppressant medications and smoking were associated with growth purulence,” Margaret Cooke, MD, said in her presentation at the Orthopaedic Trauma Association Annual Meeting. “These same factors, along with Gustilo grade, were associated with any infection.”

Cooke and colleagues retrospectively reviewed the records of 1,003 skeletally mature patients who underwent surgery for open indirect ankle fractures. For the purpose of analysis, infection was defined as a combination of superficial or deep purulence, as well as the addition of wound dehiscence.

The incidence of growth purulence was 12%, and this figure increased to 17% with the inclusion of wound dehiscence. After regression analysis, male gender, diabetes, smoking, immunosuppressant medications and time to closure remained statistically relevant. However, Cooke added BMI, dislocation and OTA classification, as well as receiving antibiotics within 6 hours or 12 hours of injury were not associated with a risk of infection.

“A longer time to debridement, longer time to closure and not having a primary closure were associated with both definitions of infection,” Cooke said.

Overall, the researchers identified 87 cases of malunion, nonunion and loss of reduction.

“Both growth purulence and any infection resulted in higher rates of these complications,” according to Cooke.

She added, “While various patient factors predispose patients to infection, there are some surgeon factors that we may have control over. In particular, time to closure had a clear effect on infection. Finally, infection in this population led to other complications of malunion, nonunion and loss of reduction.” — by Casey Tingle

Reference:

Tornetta P, et al. Paper #107. Presented at: Orthopaedic Trauma Association Annual Meeting. Oct. 7-10, 2015; San Diego.

Disclosure: Cooke reports no relevant financial disclosures.