Nutritional status and wound healing in open fractures of the lower limb

Abstract

Forty-three patients averaging 28.2 (range 16-74) years with open fractures of the lower limbs were studied prospectively for 40 weeks using anthropometrical, biochemical and haematological parameters to ascertain their relationship to wound healing following injury. Nearly half (21/43) of the patients were malnourished at admission and the number increased to 22 a week after injury. Dietary advice and better food intake improved nutritional status with only 13 patients remaining malnourished at the 40th week. Wound healing was earlier when creatinine-height index was normal throughout the course of treatment and was delayed when serum albumin level was low.Résumé Nous avons suivi prospectivement, pendant quarante semaines, 43 malades avec des fractures combinées du membre inférieur en utilisant des paramètres anthropométrique, biochimique et hématologique pour étudier leur relation avec la cicatrisation des parties molles après l'accident. Prés de la moitié des patients (21/43) étaient considérés comme malnutris à leur admission. Les conseils diététiques et une meilleure prise de la nourriture ont amélioré le statut nutritionnel avec seulement treize malades dans le groupe malnutris à la quarantième semaine. La guérison des blessures était plus précoce quand l'index de créatinine était normal durant le cours du traitement et a été retardée quand le niveau de sérum albumine était bas.

Influence of Body Mass Index and Antibiotic Dose on the Risk of Surgical Site Infections in Pediatric Clean Orthopedic Surgery

“…Additionally, underweight children may not have the immunologic reserve to defend against an infection because of their poor nutritional status, as poor nutritional status has been suggested to contribute to decreased lymphocyte function [18,19]. Furthermore, good nutritional status is crucial for wound healing, which could contribute to this association and has been demonstrated in other studies [20,21]. However, in multivariable analysis, this finding was not found to reach statistical significance.…”

Does The Nutritional Status Changes The Healing Outcome Of Simple Diaphysel Tibial Fractures In Adults: A Prospective Cohort Study

“…As per our knowledge, Dwyer et al 15 was the first to studied the association of nutritional status on healing of tibial fractures in humans. In that study, 34 patients with open tibial fracture were followed for 40 weeks.…”

“…[8][9] Many of the factors are responsible for fracture impairment, [10][11] including nutritional status of the patient. [12][13][14][15] Based on above findings, we planned the study to correlate the tibial fracture healing outcomes with nutritional status by taking serum albumin and serum ferritin as a nutritional status indicator of the patients and hypothesised that the fracture healing outcomes of tibial fractures was significantly associated with these nutritional status parameters of the treating patients.…”

“…Some authors have used albumin levels alone as a laboratory indicator for malnutrition in orthopaedic patients [16][17][18] . Many studies had been correlated protein depletion with increased mortality and morbidity, wound infection, surgical failure, sepsis as well as impaired fracture union and wound healing 19,[12][13][14][15] . Koval et al in a study also demonstrated that albumin level of < 3.5 g/dl was predictive of delay of fracture to heal, increased length of hospital stay as well as their mortality rate 20 .…”

“…Fractures impairment may be caused by several factors such as extensive soft tissue damage, the presence of a gap at the fracture site, poor mechanical stability, open fractures, administration of pharmacological agents, such as NSAIDs and smoking, etc [10][11] . The potential role of nutritional health in the fracture healing outcomes among individuals also known [12][13][14][15] . But till now, they are not in use as a prognostic marker, in parallel to clinic-radiological diagnosis.…”