Lee John J, Ricks Tinisha R, Garg Sunakshi, Alegun Jennifer O, Li Bohan, Klein Lauren R, Caronia Catherine G
Orthopedic Surgery, Good Samaritan University Hospital, West Islip, USA.
Podiatry, Good Samaritan University Hospital, West Islip, USA.
Cureus. 2024 Nov 13;16(11):e73625. doi: 10.7759/cureus.73625. eCollection 2024 Nov.
Background and aims Ankle injuries are one of the most common lower extremity traumas reported, with nearly half needing surgical intervention. For those who undergo surgical treatment, surgical site infection (SSI) is not a rare complication. Cefazolin is the recommended preoperative surgical chemoprophylaxis for surgical site infection. This exploratory study sought to evaluate the efficacy of cefazolin prophylaxis at the time of primary open reduction and internal fixation (ORIF) for ankle fractures compared to the efficacy of non-cefazolin chemoprophylaxis with respect to wound complications. Methods A single-center retrospective study of adult patients who underwent open reduction and internal fixation (ORIF) of a closed ankle fracture between January 1, 2012, and April 11, 2023, was conducted at Good Samaritan University Hospital. Patients were compared based on the perioperative antibiotic received per our hospital's guidelines: cefazolin (given by weight: 2 g < 120 kg and 3 g ≥ 120 kg) or a non-cefazolin alternative for a reported cefazolin or penicillin allergy (clindamycin 900 mg and/or vancomycin 1 g < 80 kg or 1.5 g ≥ 80 kg). Group 1 consisted of 132 patients who underwent ORIF of the ankle after having received cefazolin. Group 2 consisted of 19 patients who underwent ORIF of the ankle after having received a non-cefazolin antibiotic. The outcomes measured were postoperative infection, infection requiring surgery, and dehiscence. Associations between the American Society of Anesthesiologists (ASA) physical classification score, body mass index (BMI), and ankle fracture classification and our primary outcomes were also reviewed. Results Of the 151 patients, 22 patients were reported to have complications. Complications were defined as postoperative infection, infection requiring surgery, and dehiscence. There was no statistically significant difference in these complication rates (infection, p = 0.9; infection requiring surgery, p = 0.6; and dehiscence, p = 0.5) between the cefazolin and non-cefazolin cohorts. The average follow-up time after surgery in both groups was eight months. Conclusions There were no significant differences in complication rates between the cefazolin and non-cefazolin cohorts. In turn, prophylactic antibiotic type, among those reported in this study, does not appear to be a prominent influence on the rate of wound complications in ORIF of ankle fractures. The sample size of this study, however, is a major limitation. These results can help guide a larger study of the efficacy of antibiotic chemoprophylaxis choice in ankle ORIF surgeries.
背景与目的 踝关节损伤是报告中最常见的下肢创伤之一，近半数患者需要手术干预。对于接受手术治疗的患者而言，手术部位感染（SSI）并非罕见的并发症。头孢唑林是推荐用于预防手术部位感染的术前外科化疗药物。本探索性研究旨在评估在初次切开复位内固定（ORIF）治疗踝关节骨折时，头孢唑林预防与非头孢唑林化疗预防在伤口并发症方面的疗效。方法 在善萨玛利亚大学医院对2012年1月1日至2023年4月11日期间接受闭合性踝关节骨折切开复位内固定（ORIF）的成年患者进行单中心回顾性研究。根据我院指南，根据围手术期接受的抗生素对患者进行比较：头孢唑林（按体重给药：体重<120 kg给予2 g，体重≥120 kg给予3 g）或针对报告有头孢唑林或青霉素过敏的非头孢唑林替代药物（体重<80 kg给予克林霉素900 mg和/或万古霉素1 g，体重≥80 kg给予1.5 g）。第1组由132例接受头孢唑林治疗后行踝关节ORIF的患者组成。第2组由19例接受非头孢唑林抗生素治疗后行踝关节ORIF的患者组成。所测量的结局为术后感染、需要手术的感染和伤口裂开。还回顾了美国麻醉医师协会（ASA）身体分类评分、体重指数（BMI）和踝关节骨折分类与我们的主要结局之间的关联。结果 在151例患者中，有22例报告有并发症。并发症定义为术后感染、需要手术的感染和伤口裂开。头孢唑林组和非头孢唑林组在这些并发症发生率方面无统计学显著差异（感染，p = 0.9；需要手术的感染，p = 0.6；伤口裂开，p = 0.5）。两组术后平均随访时间均为8个月。结论 头孢唑林组和非头孢唑林组在并发症发生率方面无显著差异。相应地，在本研究报告的药物中，预防性抗生素类型似乎对踝关节骨折ORIF的伤口并发症发生率没有显著影响。然而，本研究的样本量是一个主要限制因素。这些结果有助于指导对踝关节ORIF手术中抗生素化疗预防选择疗效的更大规模研究。
