A nomogram for predicting skin necrosis risk after open reduction and internal fixation for tibia fractures

Abstract

The purpose of our study was to determine the risk factors for skin necrosis after open reduction and internal fixation (ORIF) for tibia fracture and establish a nomogram prediction model. We retrospectively analysed the clinical data of patients who suffered from tibia fractures and had been surgically treated by ORIF in our institution between August 2015 and October 2020. Perioperative information was obtained through the electronic medical record system, univariate and multivariate analyses were performed to determine the risk factors of skin necrosis, and a nomogram model was constructed to predict the risk of skin necrosis. The predictive performance and consistency of the model were evaluated by the Hosmer-Lemeshow (H-L) test and the calibration curve. In total, 444 patients were enrolled in our study. Multivariate analysis results showed that limb swelling, time until the operation, operation time, distance from fracture end to the skin, and softtissue injury (Tscherne classification type 3) were independent risk factors for skin necrosis. The AUC value for skin necrosis risk was 0.906 (95% confidence interval 0.88$0.94). The H-L test revealed that the nomogram prediction model had good calibration ability (P = .467). Finally, we found a correlation between skin necrosis and limb swelling, time until the operation, operation time, distance from fracture end to the skin, and soft-tissue injury (Tscherne classification type 3) after ORIF for tibia fracture patients.Our nomogram prediction model might be helpful for clinicians to identify high-risk patients, as interventions could be taken early to reduce the incidence of skin necrosis.

A nomogram for predicting post‐operative wound complications after open reduction and internal fixation for calcaneal fractures

“…This is especially true in high‐energy calcaneal fractures, where a compromised soft tissue envelope with extensive oedema, fracture blisters, and ecchymosis may be present. 39 , 40 Many surgeons performed surgery after detumescence of the injured foot and suggested that it is critical to avoid soft‐tissue complications. Generally, calcaneal fractures are caused by high‐energy impacts, and the relatively thin coverage of soft tissue on the heel also suffers severe injury.…”

“…It is vitally important for the surgeon to delay surgery until the swelling subsides sufficiently, since wound edge necrosis, skin slough, and postoperative infections can be the consequence of a prematurely performed ORIF. This is especially true in high‐energy calcaneal fractures, where a compromised soft tissue envelope with extensive oedema, fracture blisters, and ecchymosis may be present 39,40 . Many surgeons performed surgery after detumescence of the injured foot and suggested that it is critical to avoid soft‐tissue complications.…”