Matson Andrew P, Morwood Michael P, Peres Da Silva Ashwin, Cone Eugene B, Hurwitz Shepard R, Zura Robert D
Duke University School of Medicine, Durham, North Carolina (APM, MPM, APDS, EBC).
University of North Carolina School of Medicine, Chapel Hill, North Carolina (SRH).
Foot Ankle Spec. 2017 Oct;10(5):435-440. doi: 10.1177/1938640016685146. Epub 2016 Dec 28.
Outcomes following ankle fracture surgery have been well studied; however, factors associated with surgical wound healing specifically are less clear. We aimed to study the relationship between wound healing and body mass index, as well as other variables following surgical treatment of ankle fractures. There were 127 consecutive, isolated, closed, malleolar ankle fractures treated with open reduction and internal fixation at a level-1 trauma center from 2008 to 2012. Patient, injury, and treatment variables were recorded and clinical records were reviewed to identify wound complications. There were 6 major and 18 minor wound complications. The overall rate of wound complication of any type was significantly lower in obese patients at 11.7% (7/60) compared with 25.4% (17/67, P < .05) in nonobese patients. When controlling for other variables obesity was associated with a significantly lower risk of developing a wound complication (OR 0.267, 95% CI 0.087-0.822), as was low energy mechanism (OR 0.246, 95% CI 0.067-0.906). No other covariates tested were associated with an increased risk of a wound infection. Ankle anatomy may present a unique situation whereby obesity may be protective against wound complications. Further studies are needed to confirm this clinical observation, and to demonstrate the mechanism through which this may occur.
Therapeutic, Level IV: Retrospective.
踝关节骨折手术后的结果已得到充分研究；然而，与手术伤口愈合具体相关的因素尚不清楚。我们旨在研究踝关节骨折手术治疗后伤口愈合与体重指数以及其他变量之间的关系。2008年至2012年期间，在一家一级创伤中心对127例连续、孤立、闭合的踝关节骨折进行了切开复位内固定治疗。记录患者、损伤和治疗变量，并查阅临床记录以确定伤口并发症。有6例主要伤口并发症和18例次要伤口并发症。肥胖患者任何类型伤口并发症的总体发生率显著低于非肥胖患者，分别为11.7%（7/60）和25.4%（17/67，P <.05）。在控制其他变量时，肥胖与伤口并发症发生风险显著降低相关（OR 0.267，95%CI 0.087 - 0.822），低能量损伤机制也是如此（OR 0.246，95%CI 0.067 - 0.906）。测试的其他协变量均与伤口感染风险增加无关。踝关节解剖结构可能呈现一种独特情况，即肥胖可能对伤口并发症具有保护作用。需要进一步研究来证实这一临床观察结果，并阐明其可能发生的机制。
治疗性，四级：回顾性研究。
