Hadeed Michael M, Evans Cody L, Werner Brian C, Novicoff Wendy M, Weiss David B
University of Virginia, Department of Orthopaedic Surgery, Charlottesville, VA, United States.
University of Virginia, Department of Orthopaedic Surgery, Charlottesville, VA, United States.
Injury. 2019 Feb;50(2):503-507. doi: 10.1016/j.injury.2018.10.041. Epub 2018 Nov 1.
Tibial pilon fractures are often treated with initial external fixation followed by delayed definitive fixation. It has been postulated that the external fixator pin site may correlate with infection risk. The purpose of this study was to determine whether external fixator pin-site distance from definitive implants impacts the risk of deep infection in pilon fractures.
A retrospective cohort study was completed at a single level 1 trauma center. All patients ages 15-65 who underwent open reduction and internal fixation (ORIF) of a distal tibial fracture (AO/OTA Classification 43) from 2007 to 2013 were included. The final study population was 133 patients. The impact of external fixation pin location (relative to the definitive implant location) on postoperative infection was measured.
As a continuous variable, the distance between the closest pin site and plate was 62.1 ± 44.1 mm in the infected cohort and 62.2 ± 49.7 mm in the non-infected cohort (p = 0.991). Further analysis was performed by grouping the distances into less than 0 mm (i.e. overlapping), >0.0 - 25.0 mm, >25.0 - 50.0 mm, >50.0 - 75.0 mm, >75.0 - 100.0 mm, and >100.0 mm of separation. No significant differences were noted with regards to the risk for infection.
Staged care has been shown to be an effective treatment strategy for AO/OTA type 43 fractures. There are many variables to consider when placing an external fixator construct. In this cohort, pin site distance from definitive implant location was not associated with an increase in deep infections.
Level III.
胫骨平台骨折通常首先采用外固定治疗，随后进行延迟的确定性固定。据推测，外固定针道可能与感染风险相关。本研究的目的是确定外固定针道与确定性植入物的距离是否会影响胫骨平台骨折深部感染的风险。
在一家一级创伤中心完成了一项回顾性队列研究。纳入了2007年至2013年期间所有年龄在15 - 65岁、接受了胫骨干骺端骨折切开复位内固定术（AO/OTA分类43）的患者。最终研究人群为133例患者。测量了外固定针位置（相对于确定性植入物位置）对术后感染的影响。
作为连续变量，感染组中最近针道与钢板之间的距离为62.1±44.1毫米，非感染组为62.2±49.7毫米（p = 0.991）。通过将距离分组为小于0毫米（即重叠）、>0.0 - 25.0毫米、>25.0 - 50.0毫米、>50.0 - 75.0毫米、>75.0 - l00.0毫米和>100.0毫米进行了进一步分析。在感染风险方面未发现显著差异。
分期治疗已被证明是AO/OTA 43型骨折的有效治疗策略。放置外固定结构时需要考虑许多变量。在该队列中，针道与确定性植入物位置的距离与深部感染增加无关。
III级。
