Risk Factors for Infection and Subsequent Adverse Clinical Results in the Setting of Operatively Treated Pilon Fractures

Abstract

Objective: To determine patient-specific and injury-specific factors that may predict infection and other adverse clinical results in the setting of tibial pilon fractures.Design: Retrospective chart review.Setting: Level 1 academic trauma center. Patients:Two hundred forty-eight patients who underwent operative treatment for tibial pilon fractures between 2010 and 2020. Intervention: External fixation and/or open reduction and internal fixation.Main Outcome Measurements: Fracture-related infection rates and specific bacteriology, risk factors associated with development of a fracture-related infection, and predictors of adverse clinical results.Results: Two hundred forty-eight patients were enrolled. There was an infection rate of 21%. The 3 most common pathogens cultured were methicillin-resistant Staphylococcus aureus (20.3%), Enterobacter cloacae (16.7%), and methicillin-resistant Staphylococcus aureus (15.5%). There was no significant difference in age, sex, race, body mass index, or smoking status between those who developed an infection and those who did not. Patients with diabetes mellitus (P = 0.0001), open fractures (P = 0.0043), and comminuted fractures (OTA/AO 43C2 and 43C3) (P = 0.0065) were more likely to develop a fracture-related infection. The presence of a polymicrobial infection was positively associated with adverse clinical results (P = 0.006). History of diabetes was also positively associated with adverse results (P = 0.019).Conclusions: History of diabetes and severe fractures, such as those that were open or comminuted fractures, were positively associated with developing a fracture-related infection after the operative fixation of tibial pilon fractures. History of diabetes and presence of a polymicrobial infection were independently associated with adverse clinical results.

Comparative analysis of pathogen distribution in patients with fracture-related infection and periprosthetic joint infection: a retrospective study

“…These characteristics result in infection caused by colonizing the microbiota of the local skin [ 40 ]. Yeramosu et al [ 41 ] enrolled 248 patients who underwent operatively treated pilon fractures and declared that Enterobacter cloacae was one of the most common pathogens, accounting for 16.7%.…”

Predictors of Deep Infection After Distal Femur Fracture: A Multicenter Study

“…Higher-energy Orthopaedic Trauma Association classification types (C vs. B, 3 vs. 2) have been associated with infection in recent studies of tibial plateau fractures 22 and pilon fractures. 23 Vascular injury, present in 3.6% of this cohort, was the single most salient predictor of infection in the present analysis, having an OR of 3.9. In the classic series by Gustilo et al 24 of 87 type III open long bone fractures, vascular injuries had a similarly dramatic impact on infection rate as the rate was 42% in type IIIC injuries versus 4.4% in IIIA injuries.…”

Independent risk factor for surgical site infection after orthopedic surgery

“…Risk factors for SSIs include Gustilo grade, duration of wound exposure, wound size, whether debridement surgery is timely, whether prophylactic antibiotics are used, duration of surgery, season, and length of hospital stay. [ 17 ]…”

“…Risk factors for SSIs include Gustilo grade, duration of wound exposure, wound size, whether debridement surgery is timely, whether prophylactic antibiotics are used, duration of surgery, season, and length of hospital stay. [17] With the prolongation of survival time of patients, their age increases, their immune function gradually decreases, and their underlying diseases (such as diabetes, uremia, etc) increase, so elderly orthopedic "trauma" surgery patients are more likely to develop SSI. [18] SSI after "trauma" surgery is one of the severe complications and may reduce patients' quality of life.…”