Trauma Unit. Orthopaedic and Trauma Dept, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Injury. 2021 Jul;52 Suppl 4:S104-S108. doi: 10.1016/j.injury.2021.02.085. Epub 2021 Feb 26.
The aim of this study is to evaluate risk factors for infection as well as infection rates after open reduction and internal fixation for distal tibia fractures with a distal tibia locking plate and/or isolated screws.
This is a retrospective and descriptive study based on 55 patients treated in our Major Trauma Centre from January 2009 to December 2016. All patients were classified by age, sex, open or closed fracture, injury mechanism, comorbidities, fixation and time from injury to surgery. 22 extraarticular fractures AO/OTA 43-A and 33 intraarticular (14 cases 43-B and 19 43-C) were recorded. High energy trauma was related in 27 patients, while open fractures were observed in 10 patients. Splint until surgery was applied routinely while temporary external fixation (EF) was performed in 21 patients (7 extraarticular and 14 intraarticular). Patients were treated by 5 different consultant surgeons performing isolated screws (SC) in 20% of the surgeries, antero-medial locking distal tibia plate (AM) and anterolateral (AL) were used in 47% and 33% of the patients respectively. After assessing normality and homogeneity of the subgroups, statistical contrast tests were performed.
Infection rate was 31.5%, mainly caused by S. aureus. We obtained a statistically significant correlation between greater age and infection rate. In the same way, a positive statistical trend between infection and AL plating was found. The use of EF followed by ORIF was not observed as a risk factor for infection compared with splint followed by internal fixation, however, the group of patients in which a splint was used, a positive relationship was found between the infection rate and shorter time until the definitive fixation. No statistically significant associations were found between extra/intraarticular fracture pattern, use of corticosteroids or open fractures and infection rate.
Greater age was a predisposing factor for infection. The use of external fixation before definitive ORIF seems to be a safe procedure regarding risk infection, and if an external fixation is not used, we recommend longer waiting time until definitive ORIF. Screw fixation or antero-medial plates, if allowed by fracture pattern, can be an option to avoid infection.
本研究旨在评估采用胫骨远端锁定钢板和/或单独螺钉进行切开复位内固定治疗胫骨远端骨折后的感染相关风险因素及感染发生率。
这是一项回顾性描述性研究，共纳入我院创伤中心 2009 年 1 月至 2016 年 12 月期间收治的 55 例患者。所有患者根据年龄、性别、开放性或闭合性骨折、损伤机制、合并症、固定方式以及从受伤到手术的时间进行分类。共记录了 22 例关节外骨折（AO/OTA 43-A）和 33 例关节内骨折（14 例 43-B 和 19 例 43-C）。27 例为高能量损伤，10 例为开放性骨折。常规应用夹板固定直至手术，21 例患者（7 例关节外骨折和 14 例关节内骨折）采用临时外固定架固定。由 5 位不同的顾问外科医生进行治疗，其中 20%的患者采用单独螺钉固定，47%的患者采用前内侧胫骨远端锁定钢板（AM），33%的患者采用前外侧（AL）钢板。在评估亚组的正态性和同质性后，进行了统计学对比检验。
感染率为 31.5%，主要由金黄色葡萄球菌引起。我们发现年龄较大与感染率之间存在统计学显著相关性。同样，我们发现感染与 AL 钢板之间存在正相关趋势。与夹板固定后再内固定相比，外固定架固定后再切开复位内固定并不是感染的危险因素，但在使用夹板的患者中，我们发现从夹板固定到最终固定的时间与感染率之间存在正相关关系。关节外/关节内骨折模式、使用皮质类固醇或开放性骨折与感染率之间无统计学显著相关性。
年龄较大是感染的危险因素。在进行确定性切开复位内固定之前使用外固定似乎是一种安全的操作，不会增加感染风险，如果不使用外固定架，我们建议在进行确定性切开复位内固定之前等待更长的时间。如果骨折模式允许，螺钉固定或前内侧钢板固定可以作为避免感染的选择。
