Ovaska Mikko T, Madanat Rami, Honkamaa Maija, Mäkinen Tatu J
Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Topeliuksenkatu 5, 00260 Helsinki, Finland.
Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Injury. 2015 Aug;46(8):1650-5. doi: 10.1016/j.injury.2015.04.015. Epub 2015 Apr 17.
Open ankle fractures are rare injuries with a high likelihood of wound complications and subsequent infections. There is limited information about the complications and outcomes of these injuries in different age groups. The aim of this study was to assess the contemporary demographics and complications related to this injury. We performed a chart review of all the 3030 patients treated for ankle fractures at a Level 1 trauma centre from 2006 to 2011. 137 (4.5%) patients had an open ankle fracture. The demographic data, injury mechanism, comorbidities, and fracture type were collected. Treatment, complications, length of stay and number of outpatient visits were also recorded. The mean age of the patients was 60 years and 56% were women. Most fractures were Weber type B with a medial sided wound (93%). Only 20% of the fractures were the result of high-energy trauma, and 31% were Gustilo grade III injuries. Immediate internal fixation was performed in 82% of patients, and the wound was primarily closed in most cases (80%). The incidence of postoperative wound necrosis and deep infection was 18% and 17%, respectively. There were more deep infections if pulsatile lavage was used during the wound debridement (p=0.029). About 14 (10%) patients required a flap reconstruction to cover the soft-tissue defect. Every other patient (54%) had a complication, and 21 patients (15%) suffered a long-term disability related to the injury. The number complications did not differ for nighttime and daytime operations (p=0.083). High-energy injuries were more common in younger patients (p<0.001) and these patients also had more lateral sided open wounds than older patients (p=0.002). Interestingly, younger patients also had significantly more complications (p=0.024), suffered more often from chronic pain (p=0.003), and required more flap reconstructions (p=0.026), reoperations (p=0.026), and outpatient clinic visits (p=0.006). Open ankle fractures have a high complication rate and often require multiple surgical procedures. In young patients these injuries are more likely to be the consequence of high-energy trauma leading to more complications and subsequently increased healthcare resource utilisation.
开放性踝关节骨折是一种少见的损伤，伤口并发症及后续感染的可能性很高。关于不同年龄组此类损伤的并发症和预后的信息有限。本研究的目的是评估与该损伤相关的当代人口统计学特征及并发症情况。我们对2006年至2011年在一家一级创伤中心接受踝关节骨折治疗的所有3030例患者进行了病历回顾。137例（4.5%）患者为开放性踝关节骨折。收集了人口统计学数据、损伤机制、合并症及骨折类型。还记录了治疗情况、并发症、住院时间及门诊就诊次数。患者的平均年龄为60岁，56%为女性。大多数骨折为伴有内侧伤口的Weber B型（93%）。仅20%的骨折由高能创伤所致，31%为GustiloⅢ级损伤。82%的患者接受了即刻内固定，大多数情况下伤口进行了一期闭合（80%）。术后伤口坏死和深部感染的发生率分别为18%和17%。伤口清创时使用脉冲冲洗则深部感染更多（p=0.029）。约14例（10%）患者需要皮瓣重建以覆盖软组织缺损。每例患者（54%）都有并发症，21例（15%）患者因该损伤出现长期残疾。夜间和白天手术的并发症数量无差异（p=0.083）。高能损伤在年轻患者中更常见（p<0.001），且这些患者外侧开放性伤口也比老年患者更多（p=0.002）。有趣的是，年轻患者并发症也明显更多（p=0.024），慢性疼痛更常见（p=0.003），需要更多的皮瓣重建（p=0.026）、再次手术（p=0.026）及门诊就诊（p=0.006）。开放性踝关节骨折并发症发生率高，常需多次外科手术。在年轻患者中，这些损伤更可能是高能创伤的结果，导致更多并发症，进而增加医疗资源的利用。
