Wound complications after distal humerus fracture fixation: incidence, risk factors, and outcome

Lawrence, Tom; Ahmadi, Shahryar; Morrey, B.F.; Sánchez-Sotelo, Joaquín

doi:10.1016/j.jse.2013.09.014

Cited by 54 publications

(34 citation statements)

References 20 publications

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“…In prior research, olecranon osteotomy stabilized with a plate and screws was a risk factor for SSI [14], and plate and screw fixation also was found to be a risk factor for SSI in long bone fractures [29]. The data regarding SSI after plate and screw fixation of tibial plateau fractures, distal tibia fractures, proximal humerus fractures, and humeral shaft fractures are less consistent [5,8,12,15,16,23,26,30,33].…”

Section: Discussionmentioning

confidence: 99%

“…Orthopaedic SSIs prolong hospital stays by 7 to 14 days per patient [10,31] and increase healthcare costs by more than 300% [31]. The risk factors for an SSI after orthopaedic surgery include older age, other nosocomial infections, wound contamination class, rheumatoid arthritis, the use of a drain, and length of preoperative stay [9,14,24,27]. A prior study identified the elbow and tibia as independently associated with SSI after trauma [4].…”

Section: Introductionmentioning

confidence: 99%

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What Factors are Associated With a Surgical Site Infection After Operative Treatment of an Elbow Fracture?

Claessen

Braun

Leeuwen

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Surgical site infections are one of the more common major complications of elbow fracture surgery and can contribute to other adverse outcomes, prolonged hospital stays, and increased healthcare costs. Questions/purposes We asked: (1) What are the factors associated with a surgical site infection after elbow fracture surgery? (2) When taking the subset of closed elbow fractures only, what are the factors associated with a surgical site infection? (3) What are the common organisms isolated from an elbow infection after open treatment? Methods One thousand three hundred twenty adult patients underwent surgery for an elbow fracture between January 2002 and July 2014 and were included in our study. Forty-eight of 1320 patients (4%) had a surgical site infection develop. Thirty-four of 1113 patients with a closed fracture (3%) had a surgical site infection develop.Results For all elbow fractures, use of plate and screw fixation (adjusted odds ratio [OR]= 2.2; 95% CI, 1.0-4.5; p = 0.041) and use of external fixation before surgery (adjusted OR = 4.7; 95% CI, 1.1-21; p = 0.035) were associated with higher infection rates. When subset analysis was performed for closed fractures, only smoking (adjusted OR = 2.2; 95% CI, 1.1-4.5; p = 0.023) was associated with higher infection rates. Staphylococcus aureus was the most common bacteria cultured (59%). Conclusions The only modifiable risk factor for a surgical site infection after open reduction and internal fixation was cigarette smoking. Plate fixation and temporary external fixation are likely surrogates for more complex injuries, therefore no recommendations should be inferred from this association. Surgeons should counsel patients who smoke. Level of Evidence Level IV, prognostic study.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

What Factors are Associated With a Surgical Site Infection After Operative Treatment of an Elbow Fracture?

Claessen

Braun

Leeuwen

et al. 2016

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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“…Ulnar nerve transposition, although not universally recommended, can decrease neurological symptoms during the recovery process. Another issue is wound healing, Lawrence; et al found after analyzing 89 fractures that 15.7% developed a major wound complication requiring an average 2.5 additional surgical procedures (range, 1-6) [5]. They concluded that the incidence of major wound complications after fixation of a distal humerus fracture was very important, particularly in open fractures treated with an olecranon osteotomy stabilized with a plate despite bone union was usually obtained.…”

Section: Which Way Forward?mentioning

confidence: 99%

Distal Humerus Fractures: A Review of Current Literature

García-Rey¹,

García-Cimbrelo²

2019

TOORTHJ

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“…Open reduction and internal fixation is usually needed and it is difficult and complicated for surgeons to cure this type of fracture (Ring & Jupiter, 1999). Furthermore, the traditional cure or surgery for this type of fracture often leads to poor prognosis (Koh, Lim, & Lee, 2013;Lawrence, Ahmadi, & Morrey, 2014;Sharma et al, 2018). Yshaped compression plate (YCP) conforms with the dorsal anatomy of distal humerus.…”

Section: Introductionmentioning

confidence: 99%

Comparison of biomechanical characteristics in treatment of distal humerus fracture using different fixation plates: A finite element study

Zhong

Wang

et al. 2019

Microscopy Res & Technique

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With the development of digital technology of orthopedics, personalized plate has been applied to treat different kinds of fractures. However, no studies of personalized implants in the treatment of distal humeral fractures have been reported. Therefore, we design a personalized anatomical locking plate (DPALP) to treat distal humerus fracture of adult. The model of humerus and personalized plate and traditional Y‐shaped compression plate (YCP) was built and analyzed by finite element method. We found that peak value of stress of humerus fixed by YCP is higher than that of DPALP, and the peak value of stress of screws used in DPALP group is higher than that of YCP. Meanwhile, peak of displacement of YCP is higher than that of DPALP, and the peak value of displacement of humerus bone is higher than that of YCP. The patient with DPALP had a good clinical outcome (83) evaluated with Broberg and Morrey Score. Our results show that DPALP and YCP could get similar mechanical and clinical results for distal humorous intra‐articular fractures, and stress distribution of DPALP group is more balanced, and it takes less time in the operation. Furthermore, DPALP can perfectly fit the humeri and achieve the anatomical reduction. In general, DPALP is more suitable for patients with intra‐articular complicated fractures. Our findings will benefit clinicians treating distal humeral fractures and provide an alternative option.

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Wound complications after distal humerus fracture fixation: incidence, risk factors, and outcome

Cited by 54 publications

References 20 publications

What Factors are Associated With a Surgical Site Infection After Operative Treatment of an Elbow Fracture?

What Factors are Associated With a Surgical Site Infection After Operative Treatment of an Elbow Fracture?

Distal Humerus Fractures: A Review of Current Literature

Comparison of biomechanical characteristics in treatment of distal humerus fracture using different fixation plates: A finite element study

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