Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 May 6;3(2):e077.
doi: 10.1097/OI9.0000000000000077. eCollection 2020 Jun.

Factors associating with surgical site infection following operative management of malleolar fractures at an urban level 1 trauma center

Alexander S Rascoe  1 , Michael D Kavanagh  1 , Megan A Audet  1 , Emily Hu  1 , Heather A Vallier  1
Affiliations

Factors associating with surgical site infection following operative management of malleolar fractures at an urban level 1 trauma center

Alexander S Rascoe et al. OTA Int. .

Abstract

Objectives: To identify comorbidities and injury characteristics associated with surgical site infection (SSI) following internal fixation of malleolar fractures in an urban level 1 trauma setting.

Design: Retrospective.

Setting: Level 1 trauma center.

Patients/participants: Seven-hundred seventy-six consecutive patients with operatively managed malleolar fractures from 2006 to 2016.

Intervention: Open reduction internal fixation.

Main outcome measurements: Superficial SSI (erythema and drainage treated with oral antibiotics and wound care) or deep SSI (treated with surgical debridement and antibiotics).

Results: Fifty-six (7.2%) patients developed SSI, with 17 (30%) of these being deep infections. An a-priori power analysis of n = 325 (α=0.05, β=0.2) was tabulated for differences in univariate analysis. Univariate analysis identified categorical associations (P < .05) between SSI and diabetes mellitus, drug abuse, open fracture, and renal disease but not tobacco abuse, body mass index, or neuropathy. Multivariate logistic regression identified categorical associations between diabetes (OR = 2.2, 95% CI: 1.1-4.3), drug abuse (OR = 3.9, 95% CI: 1.2-12.7), open fracture (OR = 4.1, 95% CI: 1.3-12.8), and renal disease (OR = 2.7, 95% CI: 1.4-5.0) and any (superficial or deep) SSI. A separate multivariate logistic regression analysis found categorical associations between deep SSI requiring reoperation and diabetes (OR = 4.4, 95% CI: 1.6-12.2) and open fracture (OR = 4.1, 95% CI: 1.3-12.8). Furthermore, American society of anesthesiologists classification (ASA) Class 4 patients were (OR = 9.2, 95% CI: 2.0-41.79) more likely to experience an SSI than ASA Class 1 patients.

Conclusions: Factors associated with SSI following malleolar fracture surgery in a single urban level 1 trauma center included diabetes, drug abuse, renal disease, and open fracture. The presence of diabetes or open type fractures were associated with deep SSI requiring reoperation.

Level of evidence: Level 3 prognostic: retrospective cohort study.

Keywords: SSI; ankle fracture; comorbidity; complication; infection; malleolar fracture; surgical site infection.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to disclose.

References

    1. Daly PJ, Fitzgerald RH, Melton LJ, et al. Epidemiology of ankle fractures in Rochester, Minnesota. Acta Orthop Scand. 1987;58:539–544. - PubMed
    1. Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37:691–697. - PubMed
    1. Willett K, Keene DJ, Mistry D, et al. Close contact casting vs surgery for initial treatment of unstable ankle fractures in older adults: a randomized clinical trial. JAMA -. 2016;316:1455–1463. - PubMed
    1. Slobogean GP, Marra CA, Sadatsafavi M, et al. Is surgical fixation for stress-positive unstable ankle fractures cost effective? Results of a multicenter randomized control trial. J Orthop Trauma. 2012;26:652–658. - PubMed
    1. Sanders DW, Tieszer C, Corbett B. Operative versus nonoperative treatment of unstable lateral malleolar fractures: a randomized multicenter trial. J Orthop Trauma. 2012;26:129–134. - PubMed