Smeeing Diederik P J, Briet Jan P, van Kessel Charlotte S, Segers Michiel M, Verleisdonk Egbert J, Leenen Luke P H, Houwert Roderick M, Hietbrink Falco
Surgical Resident, Traumacenter Utrecht, Utrecht, The Netherlands; Surgical Resident, Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Surgical Resident, Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands.
J Foot Ankle Surg. 2018 Sep-Oct;57(5):942-947. doi: 10.1053/j.jfas.2018.03.050. Epub 2018 Jul 10.
We have described the epidemiology of complications after surgical treatment of ankle fractures and assessed which factors are associated with the most frequent complications. We conducted a retrospective cohort study at 2 level 2 and 1 level 1 trauma center in a single trauma region in the Netherlands. The study variables were collected from the electronic medical patient records; all ankle fractures were classified using the Lauge-Hansen classification, and the complications were recorded. A total of 989 patients were included from 3 hospitals, with 173 complications in 156 patients (15.8%). The most frequent complication was wound related, occurring in 101 patients (10.2%). Implant-related complications occurred in 44 patients (4.4%). Other complications, such as cast pressure spots, posttraumatic dystrophy, nonunion, impingement, and pneumonia occurred in 28 patients (2.8%). The 2 most important complications were further analyzed for risk factors. Multivariate analysis showed the risk factors for wound-related complications were advanced age, increased American Society of Anesthesiologists classification, smoking, right side symptomatic, open fracture, and initial external fixation. Most implant-related complications were caused by malreduction (n = 22) or untreated syndesmotic injury (n = 19). Malreduction was associated with supination eversion fractures (p = .059), and untreated syndesmotic injury occurred more often with pronation external rotation fractures (p < .001). The most frequent complications after ankle fracture surgery were wound- and implant-related complications. Postoperative wound-related complications were multifactorial and dependent on a combination of trauma-, patient-, and treatment-related factors. In contrast, implant-related complications resulted from the interaction between the fracture type and subsequent surgical treatment.
我们描述了踝关节骨折手术治疗后并发症的流行病学情况，并评估了哪些因素与最常见的并发症相关。我们在荷兰一个单一创伤区域的2个二级和1个一级创伤中心进行了一项回顾性队列研究。研究变量从电子医疗患者记录中收集；所有踝关节骨折均采用Lauge-Hansen分类法进行分类，并记录并发症情况。3家医院共纳入989例患者，156例患者出现173例并发症（15.8%）。最常见的并发症与伤口相关，101例患者（10.2%）出现该并发症。与植入物相关的并发症发生在44例患者（4.4%）中。其他并发症，如石膏压迫点、创伤后营养不良、骨不连、撞击和肺炎，发生在28例患者（2.8%）中。对2种最重要的并发症进一步分析其危险因素。多变量分析显示，与伤口相关并发症的危险因素为高龄、美国麻醉医师协会分级增加、吸烟、右侧有症状、开放性骨折和初始外固定。大多数与植入物相关的并发症是由复位不良（n = 22）或未治疗的下胫腓联合损伤（n = 19）引起的。复位不良与旋后外旋型骨折相关（p = 0.059），未治疗的下胫腓联合损伤在旋前外旋型骨折中更常见（p < 0.001）。踝关节骨折手术后最常见的并发症是与伤口和植入物相关的并发症。术后伤口相关并发症是多因素的，取决于创伤、患者和治疗相关因素的综合作用。相比之下，与植入物相关的并发症是由骨折类型和后续手术治疗之间的相互作用导致的。
