Thangarajah T, Prasad P S V, Narayan B
Department of Trauma and Orthopaedic Surgery, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK.
Open Orthop J. 2009 Jul 22;3:56-60. doi: 10.2174/1874325000903010056.
Ankle fracture fixation is one of the most commonly performed orthopaedic procedures. Although the results are generally favourable, complications are not uncommon, particularly in the case of surgical site infections. These have considerable impact on both postoperative morbidity and healthcare costs. Paradoxically, there is a paucity of literature studying patients who sustain them and therefore little is known about ways such occurrences can be minimised. The purpose of this study was to determine the infection rate following ankle fracture fixation and elucidate variables in their causation.
We retrospectively reviewed 50 consecutive patients who underwent open reduction and internal fixation of an ankle fracture. The study group consisted of 26 females and 24 males with an average age of 43 (Range 16-82) years.
Problems with superficial infections were noted in seven patients and deep infections in five. Of the latter, four patients underwent further surgery including two that had their metal work removed. With use of the Fisher's exact test we determined that only smoking and a bimalleolar fracture pattern were significant variables, having p-values of 0.02 and 0.04 respectively.
We recommend that patients with ankle fractures who either have a history of smoking and/or bimalleolar injury be counselled about the potential risk of infection and its implications on their functional recovery. The ability to identify patients at risk of such problems highlights the need for caution during the perioperative period so that care strategies may be altered to facilitate recovery.
踝关节骨折固定术是最常实施的骨科手术之一。尽管总体结果良好，但并发症并不罕见，尤其是手术部位感染。这些并发症对术后发病率和医疗费用都有相当大的影响。矛盾的是，研究发生手术部位感染的患者的文献很少，因此对于如何将此类情况的发生降至最低知之甚少。本研究的目的是确定踝关节骨折固定术后的感染率，并阐明其病因中的变量。
我们回顾性分析了连续50例接受踝关节骨折切开复位内固定术的患者。研究组包括26名女性和24名男性，平均年龄43岁（范围16 - 82岁）。
7例患者出现浅表感染问题，5例出现深部感染。在后者中，4例患者接受了进一步手术，其中2例取出了内固定物。通过Fisher精确检验，我们确定只有吸烟和双踝骨折类型是显著变量，p值分别为0.02和0.04。
我们建议，对于有吸烟史和/或双踝损伤的踝关节骨折患者，应告知其感染的潜在风险及其对功能恢复的影响。识别有此类问题风险的患者的能力凸显了围手术期谨慎的必要性，以便可以改变护理策略以促进恢复。
