Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, United States.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
Injury. 2024 Nov;55(11):111822. doi: 10.1016/j.injury.2024.111822. Epub 2024 Aug 13.
To evaluate risk factors for infection in severe open tibial shaft fractures.
A secondary analysis of a multicenter prospective study investigated internal versus external fixation of severe open tibia fractures at 20 US Level I trauma centers. Adult patients, aged <65 years, with a Gustilo-Anderson Type IIIB or severe IIIA metaphyseal or diaphyseal tibia fracture were included. All fractures underwent definitive fixation with either a modern ring external fixator, intramedullary device, and/or plate. Fourteen variables previously identified as risk factors for infection were included in the analysis. Deep surgical site infection was defined as an infection treated with surgical debridement within 1 year of index surgery.
The study cohort included 430 patients. Deep surgical site infection requiring reoperation occurred in 108 (25 %) patients. The final model identified four risk factors for infection: age >40 years (OR, 2.00; 95 % CI, 1.3-3.1), Gustilo-Anderson Type IIIB (OR, 1.80; 95 % CI, 1.1-3.0), embedded wound contamination (OR, 1.69; 95 % CI, 1.1-2.7), and wound length (OR, 1.02/cm; 95 % CI, 1.0-1.05). The model performed poorly at distinguishing infected from uninfected patients (Area Under the Curve=0.57; 95 % CI, 0.51-0.63).
Surgeons can now counsel patients with these risk factors that they are at a markedly higher risk of infection. The identification of these risk factors may direct future research aimed at mitigating the risk of deep surgical site infection in this patient population.
评估严重开放性胫骨骨干骨折感染的危险因素。
对 20 家美国一级创伤中心进行的一项多中心前瞻性研究进行二次分析，比较了严重开放性胫骨骨折的内固定与外固定。纳入年龄<65 岁、Gustilo-Anderson ⅢB 型或严重ⅢA型干骺端或骨干胫骨骨折的成年患者。所有骨折均采用现代环形外固定架、髓内装置和/或钢板进行确定性固定。分析中纳入了先前确定的 14 个感染危险因素。深部手术部位感染定义为索引手术后 1 年内因感染行清创术治疗的感染。
研究队列包括 430 例患者。108 例（25%）患者发生需要再次手术的深部手术部位感染。最终模型确定了感染的 4 个危险因素：年龄>40 岁（OR，2.00；95%CI，1.3-3.1）、Gustilo-Anderson ⅢB 型（OR，1.80；95%CI，1.1-3.0）、嵌入式伤口污染（OR，1.69；95%CI，1.1-2.7）和伤口长度（OR，1.02/cm；95%CI，1.0-1.05）。该模型区分感染与未感染患者的能力较差（曲线下面积=0.57；95%CI，0.51-0.63）。
外科医生现在可以告知有这些危险因素的患者，他们感染的风险明显更高。这些危险因素的确定可能会指导未来的研究，旨在降低该患者人群深部手术部位感染的风险。
