Identification of risk factors for surgical site infection after type II and type III tibial pilon fracture surgery

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.

Fracturas de pilón tibial, clasificación y tratamiento

“…Esta clasificación no solo permite reconocer las zonas anatómicas y las columnas articulares para planificar los abordajes con mayor precisión, sino que también es importante para proteger los tejidos blandos y guiar el tratamiento de las fracturas conminutas del pilón tibial. Es importante destacar que el retraso en la cicatrización de los tejidos blandos aumenta el riesgo de infección en la estructura metálica subyacente, lo que podría interferir en la unión ósea y obtener resultados peores (8,13,14,15).…”